Provider Demographics
NPI:1598033243
Name:GUPTA, RITU (APRN)
Entity Type:Individual
Prefix:MRS
First Name:RITU
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:RITU
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1239 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1522
Mailing Address - Country:US
Mailing Address - Phone:203-698-4006
Mailing Address - Fax:
Practice Address - Street 1:1239 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1522
Practice Address - Country:US
Practice Address - Phone:203-698-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily