Basic Information
| Provider Information | |||||||||
| NPI: | 1740390103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGAN | ||||||||
| FirstName: | DEIRDRE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064573648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603585970 | ||||||||
| FaxNumber: | 8603588692 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064121340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605264945 | ||||||||
| FaxNumber: | 8603588651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/12/2017 | ||||||||
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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 | 363LF0000X | 003360 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 004263133 | 05 | CT | MEDICAID |