Healthcare Provider Details

I. General information

NPI: 1720030372
Provider Name (Legal Business Name): JEANNE G ARSENAULT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax: 203-937-3845
Mailing address:
  • Phone: 203-932-5711
  • Fax: 203-937-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number001621
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: