Provider Demographics
NPI:1932842630
Name:BASCETTA, BRYNNA (APRN)
Entity Type:Individual
Prefix:
First Name:BRYNNA
Middle Name:
Last Name:BASCETTA
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 1:45 BIRDSVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06057-3306
Mailing Address - Country:US
Mailing Address - Phone:860-930-6716
Mailing Address - Fax:
Practice Address - Street 1:255 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-4744
Practice Address - Country:US
Practice Address - Phone:860-930-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner