Provider Demographics
NPI:1801832803
Name:POMARICO-DENINO, VANESSA (APRN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:POMARICO-DENINO
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 1:9 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3267
Mailing Address - Country:US
Mailing Address - Phone:203-281-6811
Mailing Address - Fax:203-287-9904
Practice Address - Street 1:9 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3267
Practice Address - Country:US
Practice Address - Phone:203-281-6811
Practice Address - Fax:203-287-9904
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001906363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0Q3519OtherHEALTHNET
CTP2739411OtherOXFORD
CT004236057Medicaid
CT400001906CT02OtherANTHEM BLUE/CROSS
CT0019062675OtherCONNECTICARE
CTP00017792OtherRAILROAD MEDICARE
CT400001906CT02OtherANTHEM BLUE/CROSS
CTP00017792OtherRAILROAD MEDICARE