Provider Demographics
NPI:1740651686
Name:PUGLIESE, ANNE ELISE (RN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:ELISE
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP-BC
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:ELISE
Other - Last Name:PUGLIESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, PMHNP-BC
Mailing Address - Street 1:PO BOX 5129
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44334-0129
Mailing Address - Country:US
Mailing Address - Phone:440-465-9982
Mailing Address - Fax:
Practice Address - Street 1:7 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3921
Practice Address - Country:US
Practice Address - Phone:603-889-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.396764163W00000X
NH076885-21163W00000X
OHCTP.020486.E363LP0808X
NH076885-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH189508Medicaid