Provider Demographics
NPI:1811970551
Name:MEYER, JACQUELYN A (APRN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:A
Last Name:MEYER
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 1:71 EAST AVE
Mailing Address - Street 2:SUITE V
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4903
Mailing Address - Country:US
Mailing Address - Phone:203-656-1452
Mailing Address - Fax:203-656-1485
Practice Address - Street 1:71 EAST AVE
Practice Address - Street 2:SUITE V
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4903
Practice Address - Country:US
Practice Address - Phone:203-656-1452
Practice Address - Fax:203-656-1485
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001136364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO500000906Medicare UPIN
CTS53186Medicare UPIN