Provider Demographics
NPI:1508290388
Name:MORONI, ERIN L (APRN)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:L
Last Name:MORONI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:L
Other - Last Name:RADOCCHIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1250 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4405
Mailing Address - Country:US
Mailing Address - Phone:203-388-9250
Mailing Address - Fax:
Practice Address - Street 1:1250 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4405
Practice Address - Country:US
Practice Address - Phone:203-388-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily