Provider Demographics
NPI:1720030844
Name:PLUKAS SMITH, ELLIE (RN , APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:ELLIE
Middle Name:
Last Name:PLUKAS SMITH
Suffix:
Gender:F
Credentials:RN , APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1223
Mailing Address - Country:US
Mailing Address - Phone:860-651-7162
Mailing Address - Fax:
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:860-667-6763
Practice Address - Fax:860-667-6872
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE34147163W00000X
CT001462363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse