Healthcare Provider Details

I. General information

NPI: 1407367113
Provider Name (Legal Business Name): HEATHER CERASALE APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ELM ST
WEST HAVEN CT
06516-4233
US

IV. Provider business mailing address

PO BOX 415126
BOSTON MA
02241-5126
US

V. Phone/Fax

Practice location:
  • Phone: 203-479-3600
  • Fax:
Mailing address:
  • Phone: 203-479-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number106340
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7300
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: