Provider Demographics
NPI:1356711311
Name:DELUCA-BACHMAN, ASSUNTA (APRN)
Entity type:Individual
Prefix:
First Name:ASSUNTA
Middle Name:
Last Name:DELUCA-BACHMAN
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 1:42 RUELA DR
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:324 ELM ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2280
Practice Address - Country:US
Practice Address - Phone:203-880-5535
Practice Address - Fax:203-907-1234
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily