Provider Demographics
NPI:1356432876
Name:ROCHE, MARY A (APRN NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:ROCHE
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Gender:F
Credentials:APRN NP
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Mailing Address - Street 1:499 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-678-7300
Mailing Address - Fax:860-677-2693
Practice Address - Street 1:499 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-678-7300
Practice Address - Fax:860-677-2693
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001332364SW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004226850Medicaid
CT004226850Medicaid
S64433Medicare UPIN