Provider Demographics
NPI:1629519863
Name:IERACI, JOSEPHINE
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:IERACI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TALCOTT FOREST RD
Mailing Address - Street 2:APT G
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3581
Mailing Address - Country:US
Mailing Address - Phone:347-523-2785
Mailing Address - Fax:
Practice Address - Street 1:8 TALCOTT FOREST RD
Practice Address - Street 2:APT G
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3581
Practice Address - Country:US
Practice Address - Phone:347-523-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program