=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235186255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNIE VIRGINIA PASACRETA APRN, PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2006
-----------------------------------------------------
Last Update Date | 03/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 ABBEY LN
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06470-2784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-270-0080
-----------------------------------------------------
Fax | 203-304-1191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 ABBEY LN
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06470-2784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-270-0080
-----------------------------------------------------
Fax | 203-304-1191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 001359
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------