Provider Demographics
NPI:1609855162
Name:PAQUETTE, MARY T (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:T
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 WILBRAHAM RD
Mailing Address - Street 2:HEALTH SERVICES
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-2612
Mailing Address - Country:US
Mailing Address - Phone:413-782-1211
Mailing Address - Fax:413-796-2255
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-646-1222
Practice Address - Fax:860-465-3203
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001667363L00000X
MA169316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004258283Medicaid
CT1609855162Medicaid
CT500001643Medicare PIN
CT1609855162Medicaid
S58702Medicare UPIN