Doctor Name: | COLLEEN MARY PERUTA |
NPI Number: | 1144502386 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 4790 |
Business Practice Address: | 825 Meriden Waterbury Tpke Southington, CT - 064894156 |
Business Phone Number: | 8606212673 |
Business Fax Number: | |
Mailing Address: | 825 Meriden Waterbury Tpke, SOUTHINGTON |
State: | CT |
Postal Code: | 064894156 |
Phone Number: | 8606212673 |
Fax Number: | |
NPI Enumeration Date: | 09/14/2011 |
NPI Last Update Date: | 09/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 4790 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |