Basic Information
| Provider Information | |||||||||
| NPI: | 1245321025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCIANO | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 528 PRUDDEN LN | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064772327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1203298458 | ||||||||
| FaxNumber: | 2033320876 | ||||||||
| Practice Location | |||||||||
| Address1: | 982 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066081913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036963260 | ||||||||
| FaxNumber: | 2033320376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 000004 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 004234788 | 05 | CT | MEDICAID |