Provider Demographics
NPI:1750681003
Name:MARCUCIO, ELIZABETH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:MARCUCIO
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 1:755 CAMPBELL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3715
Mailing Address - Country:US
Mailing Address - Phone:203-889-2297
Mailing Address - Fax:203-889-2249
Practice Address - Street 1:755 CAMPBELL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3715
Practice Address - Country:US
Practice Address - Phone:203-889-2297
Practice Address - Fax:203-889-2249
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004531363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004531OtherLICENSE