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General NPI Number Information
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NPI Number | 1104829720
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Entity Type | Individual
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Provider Name | RICHARD V PANETTA APRN
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Gender | Male
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | NP RESOURCES, LLC. SIX COPRPORATE DRIVE, SUITE 420
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City | SHELTON
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State | CT
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Zip | 06484
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Country | US
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Telephone | 203-925-9600
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Fax | 203-926-0594
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Provider Business Mailing Address
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Address Line | 95 MARNEY DR
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City | MIDDLEBURY
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State | CT
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Zip | 06762-2024
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Country | US
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Telephone | 203-758-8350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 002011
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 002011
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License Number State | CT
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