Provider Demographics
NPI:1932112687
Name:COPPETO, PATRICIA A (APRN CRNA MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:COPPETO
Suffix:
Gender:F
Credentials:APRN CRNA MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2101
Mailing Address - Country:US
Mailing Address - Phone:203-910-8181
Mailing Address - Fax:860-430-9399
Practice Address - Street 1:21 SOUTHGATE DR
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2101
Practice Address - Country:US
Practice Address - Phone:203-910-8181
Practice Address - Fax:860-430-9399
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002464367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430000767Medicare ID - Type Unspecified