Healthcare Provider Details

I. General information

NPI: 1255444527
Provider Name (Legal Business Name): MICHELLE L PURCARO MSN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CHASE PKWY SUITE A
WATERBURY CT
06708
US

IV. Provider business mailing address

1075 CHASE PKWY SUITE A
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-591-3077
  • Fax: 203-591-3074
Mailing address:
  • Phone: 203-591-3077
  • Fax: 203-591-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberE57760
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002095
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: