Basic Information
Provider Information
NPI: 1275967531
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRUCCI
FirstName: CHRISTINA
MiddleName: HUMPHREY
NamePrefix: MRS.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 GEORGE ST
Address2: FL 6
City: NEW HAVEN
State: CT
PostalCode: 065116624
CountryCode: US
TelephoneNumber: 2037856610
FaxNumber: 2037856414
Practice Location
Address1: 20 YORK STREET
Address2: NP 14, GYN-ONCOLOGY
City: NEW HAVEN
State: CT
PostalCode: 065102064
CountryCode: US
TelephoneNumber: 2032006614
FaxNumber: 2032006781
Other Information
ProviderEnumerationDate: 08/22/2013
LastUpdateDate: 04/08/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X5479CTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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