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General NPI Number Information
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NPI Number | 1790394518
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Entity Type | Individual
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Provider Name | JENNA DELUCIA APRN
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Gender | Female
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 761 MAIN AVE STE 106
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City | NORWALK
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State | CT
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Zip | 06851-1080
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Country | US
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Telephone | 203-846-8885
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Fax | 203-846-6032
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Provider Business Mailing Address
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Address Line | 761 MAIN AVE STE 106
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City | NORWALK
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State | CT
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Zip | 06851-1080
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Country | US
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Telephone | 203-846-8885
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Fax | 203-846-6032
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 9033
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 164932
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License Number State | CT
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