Basic Information
| Provider Information | |||||||||
| NPI: | 1427327071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THREAT | ||||||||
| FirstName: | VONETTA | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 AVALON DR | ||||||||
| Address2: | |||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064847607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035138668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 727 HONEYSPOT RD | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066157172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033757542 | ||||||||
| FaxNumber: | 2033320376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2011 | ||||||||
| LastUpdateDate: | 02/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 004782 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 004234788 | 05 | CT | MEDICAID |