Provider Demographics
NPI:1497101265
Name:ADVANCE PRACTICE RESOURCE NETWORK LLC
Entity Type:Organization
Organization Name:ADVANCE PRACTICE RESOURCE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOSI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-596-0857
Mailing Address - Street 1:969 W MAIN ST
Mailing Address - Street 2:SUITE 1 D
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2653
Mailing Address - Country:US
Mailing Address - Phone:203-596-0857
Mailing Address - Fax:203-900-0672
Practice Address - Street 1:969 W MAIN ST
Practice Address - Street 2:SUITE 1 D
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2653
Practice Address - Country:US
Practice Address - Phone:203-596-0857
Practice Address - Fax:203-900-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty