Provider Demographics
NPI:1144415514
Name:ARCUNI, SUZANNE E (APRN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:ARCUNI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:BOISSEVAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:28 CRESCENT ST
Mailing Address - Street 2:MHS PRIMARY CARE, INC.
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-358-4820
Mailing Address - Fax:860-358-6748
Practice Address - Street 1:147 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1512
Practice Address - Country:US
Practice Address - Phone:860-767-8265
Practice Address - Fax:860-358-8653
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500002154Medicare PIN
CTS55259Medicare UPIN