Provider Demographics
NPI:1609880905
Name:NEALON, DEENNA (APRN)
Entity Type:Individual
Prefix:
First Name:DEENNA
Middle Name:
Last Name:NEALON
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 1:2 CORPORATE DRIVE, SUITE 110
Mailing Address - Street 2:FAIRFIELD COUNTY INTEGRATIVE FAMILY MEDICINE, LLC
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1376
Mailing Address - Country:US
Mailing Address - Phone:203-445-9060
Mailing Address - Fax:203-445-9093
Practice Address - Street 1:2 CORPORATE DRIVE, SUITE 110
Practice Address - Street 2:FAIRFIELD COUNTY INTEGRATIVE FAMILY MEDICINE, LLC
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1376
Practice Address - Country:US
Practice Address - Phone:203-445-9060
Practice Address - Fax:203-445-9093
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400089302OtherMEDICARE PTAN
CT0042048800Medicaid
CTD400089302OtherMEDICARE PTAN