Provider Demographics
NPI:1427327071
Name:THREAT, VONETTA ELAINE (APRN)
Entity type:Individual
Prefix:MS
First Name:VONETTA
Middle Name:ELAINE
Last Name:THREAT
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 1:2110 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-7607
Mailing Address - Country:US
Mailing Address - Phone:203-513-8668
Mailing Address - Fax:
Practice Address - Street 1:727 HONEYSPOT RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7172
Practice Address - Country:US
Practice Address - Phone:203-375-7542
Practice Address - Fax:203-332-0376
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004234788Medicaid
CT004234788Medicaid