Provider Demographics
NPI:1326072166
Name:BRACCO, MAUREEN (APRN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BRACCO
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 1:183 N MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-4325
Mailing Address - Country:US
Mailing Address - Phone:860-827-4180
Mailing Address - Fax:860-223-0132
Practice Address - Street 1:183 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-4325
Practice Address - Country:US
Practice Address - Phone:860-827-4180
Practice Address - Fax:860-223-0132
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003423363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003423OtherLIC