Provider Demographics
NPI:1043972961
Name:NELSON-PEPKA, NICOLA NATALIE
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:NATALIE
Last Name:NELSON-PEPKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SEABURY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2661
Mailing Address - Country:US
Mailing Address - Phone:860-243-6074
Mailing Address - Fax:
Practice Address - Street 1:250 SEABURY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2661
Practice Address - Country:US
Practice Address - Phone:860-243-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT151957163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology