Provider Demographics
NPI:1154320562
Name:PERUGINI, LOUANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:LOUANN
Middle Name:
Last Name:PERUGINI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:LOUANN
Other - Middle Name:
Other - Last Name:PERUGINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, ACNP, DCNP
Mailing Address - Street 1:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-8252
Mailing Address - Country:US
Mailing Address - Phone:203-456-0600
Mailing Address - Fax:
Practice Address - Street 1:849 BOSTON POST RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3537
Practice Address - Country:US
Practice Address - Phone:912-659-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5220171000000X
MDR190982363LA2100X, 363LF0000X
GA166646363LA2100X
CT12.005229363LF0000X
PASP011144363LF0000X, 171000000X
GAR166646171000000X, 363LX0106X
CT5229363LX0106X
CT005229363LF0000X
GANP166646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171000000XOther Service ProvidersMilitary Health Care Provider
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCSP.0054285OtherCONTROLLED SUBSTANCE REGISTRATION
CTMP3198670OtherDEA
CTCSP.0054285OtherCONTROLLED SUBSTANCE REGISTRATION