Provider Demographics
NPI:1629053889
Name:MUNN, NANCY IRENE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:IRENE
Last Name:MUNN
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 1:17 FARVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1805
Mailing Address - Country:US
Mailing Address - Phone:203-775-3805
Mailing Address - Fax:
Practice Address - Street 1:680 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4610
Practice Address - Country:US
Practice Address - Phone:203-576-8168
Practice Address - Fax:203-576-8435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000476363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics