Provider Demographics
NPI:1255444527
Name:PURCARO, MICHELLE L (MSN APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:PURCARO
Suffix:
Gender:F
Credentials:MSN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 CHASE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-591-3077
Mailing Address - Fax:203-591-3074
Practice Address - Street 1:1075 CHASE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-591-3077
Practice Address - Fax:203-591-3074
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE57760163WX0200X
CT002095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3521911693003OtherEMPLOYER ID
400002095CT01OtherANTHEM BCBS
00422805400OtherWORKERS COMP
500028949OtherRAILROAD MEDICARE
002095OtherSTATE ID
2V3630OtherHEALTHNET
CT004228054Medicaid
264072OtherWELLCARE
00422805400OtherWORKERS COMP
CT004228054Medicaid