Basic Information
| Provider Information | |||||||||
| NPI: | 1700504909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEPOMUCENO | ||||||||
| FirstName: | ERWIN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 ROBERTA DR | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064575510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607594792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 STATE ST | ||||||||
| Address2: | |||||||||
| City: | MERIDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064503293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032273642 | ||||||||
| FaxNumber: | 2036861677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2022 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 113117 | CT | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 010886 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.