Provider Demographics
NPI:1700504909
Name:NEPOMUCENO, ERWIN (APRN)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:NEPOMUCENO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROBERTA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5510
Mailing Address - Country:US
Mailing Address - Phone:860-759-4792
Mailing Address - Fax:
Practice Address - Street 1:1952 WHITNEY AVE STE 14
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1209
Practice Address - Country:US
Practice Address - Phone:203-776-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10886363LF0000X
CT113117163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse