Provider Demographics
NPI:1972293546
Name:QUERETTE, RONALD (LPN)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:QUERETTE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2559
Mailing Address - Country:US
Mailing Address - Phone:203-913-3548
Mailing Address - Fax:
Practice Address - Street 1:661 ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2559
Practice Address - Country:US
Practice Address - Phone:203-913-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT33945164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse