Provider Demographics
NPI:1093887994
Name:PANAPADA, MARCI (APRN)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:PANAPADA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PECK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2308
Mailing Address - Country:US
Mailing Address - Phone:203-239-4627
Mailing Address - Fax:203-234-8533
Practice Address - Street 1:13 PECK ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2308
Practice Address - Country:US
Practice Address - Phone:203-239-4627
Practice Address - Fax:203-234-8533
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003534363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTSTATE LICENSEOther003534