Provider Demographics
NPI:1104829720
Name:PANETTA, RICHARD V (APRN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:V
Last Name:PANETTA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MARNEY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2024
Mailing Address - Country:US
Mailing Address - Phone:203-758-8350
Mailing Address - Fax:
Practice Address - Street 1:NP RESOURCES, LLC.
Practice Address - Street 2:SIX COPRPORATE DRIVE, SUITE 420
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:203-925-9600
Practice Address - Fax:203-926-0594
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002011363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004195865Medicaid
CT500001412Medicare ID - Type Unspecified
CTS67045Medicare UPIN