Provider Demographics
NPI:1275536369
Name:GALVEZ-PISCIONIERE, JEANETTE S (APRN)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:S
Last Name:GALVEZ-PISCIONIERE
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 1:18 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2030
Mailing Address - Country:US
Mailing Address - Phone:203-667-4678
Mailing Address - Fax:
Practice Address - Street 1:18 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2030
Practice Address - Country:US
Practice Address - Phone:203-667-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002985363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004241759Medicaid
CTQ07138Medicare UPIN
CT004241759Medicaid