Provider Demographics
NPI:1588614465
Name:FANALE, ROSEMARY (APRN)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:FANALE
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 1:21 WATERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2097
Mailing Address - Country:US
Mailing Address - Phone:860-674-2691
Mailing Address - Fax:860-677-6443
Practice Address - Street 1:21 WATERVILLE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2097
Practice Address - Country:US
Practice Address - Phone:860-674-2691
Practice Address - Fax:860-677-6443
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001543363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner