Provider Demographics
NPI:1891043964
Name:DIABETES CARE CENTER LLC
Entity Type:Organization
Organization Name:DIABETES CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:203-527-5871
Mailing Address - Street 1:115 WATERBURY RD
Mailing Address - Street 2:STE 3
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1254
Mailing Address - Country:US
Mailing Address - Phone:203-527-5871
Mailing Address - Fax:203-528-4136
Practice Address - Street 1:115 WATERBURY RD
Practice Address - Street 2:STE 3
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1254
Practice Address - Country:US
Practice Address - Phone:203-527-5871
Practice Address - Fax:203-528-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty