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General NPI Number Information
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NPI Number | 1578022166
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Entity Type | Individual
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Provider Name | DAEDLY POTUSEK APRN
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Gender | Female
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2200 WHITNEY AVE STE 290
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City | HAMDEN
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State | CT
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Zip | 06518-3695
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Country | US
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Telephone | 203-903-8308
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Fax | 203-599-3927
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Provider Business Mailing Address
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Address Line | 2661 WHITNEY AVENUE
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City | HAMDEN
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State | CT
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Zip | 06518
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 8133
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License Number State | CT
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