Provider Demographics
NPI:1366496796
Name:PINETTE, CHRISTINE A (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:PINETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2016
Mailing Address - Country:US
Mailing Address - Phone:860-224-5762
Mailing Address - Fax:860-224-5956
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5762
Practice Address - Fax:860-224-5956
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001164363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS58137Medicare UPIN