Provider Demographics
NPI:1184686669
Name:DUNCASTER
Entity Type:Organization
Organization Name:DUNCASTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:LEEANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SHAW-QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-380-5150
Mailing Address - Street 1:40 LOEFFLER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2262
Mailing Address - Country:US
Mailing Address - Phone:860-380-5150
Mailing Address - Fax:
Practice Address - Street 1:40 LOEFFLER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2262
Practice Address - Country:US
Practice Address - Phone:860-380-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002642363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP47237Medicare UPIN