Provider Demographics
NPI:1871630327
Name:WESSMAN-PELLETIER, AMY CHARLOTTE (APRN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CHARLOTTE
Last Name:WESSMAN-PELLETIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:CHARLOTTE
Other - Last Name:WESSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 GREAT MEADOW RD
Mailing Address - Street 2:SUITE208
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2355
Mailing Address - Country:US
Mailing Address - Phone:860-563-0700
Mailing Address - Fax:860-563-0741
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5266
Practice Address - Fax:860-826-4992
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE59733163W00000X
CT003183367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT430001130Medicare ID - Type Unspecified