Provider Demographics
NPI:1265416556
Name:SPOLLETT, GERALYN R (APRN)
Entity type:Individual
Prefix:
First Name:GERALYN
Middle Name:R
Last Name:SPOLLETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 HOWARD AVE
Mailing Address - Street 2:DANA BUILDING, 3RD FL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-737-1932
Mailing Address - Fax:203-785-3588
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:DANA BUILDING, 3RD FL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-737-1932
Practice Address - Fax:203-785-3588
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004212049Medicaid
P17490Medicare UPIN
CT004212049Medicaid