Provider Demographics
NPI:1518160514
Name:LUZZI MUZYKA, MICHELE RENE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENE
Last Name:LUZZI MUZYKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:LUZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 PARK ST
Mailing Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER OFFICE OF CARE MANAGEM
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-7417
Mailing Address - Fax:203-974-7413
Practice Address - Street 1:34 PARK ST
Practice Address - Street 2:CONNECTICUT MENTAL HEALTH CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-7417
Practice Address - Fax:203-974-7413
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE48926364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT890000346Medicare ID - Type UnspecifiedFIRST COAST