Provider Demographics
NPI:1902988231
Name:STANEK, JESSICA A (CNM)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:STANEK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:PIPITONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 WATERBURY RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1225
Mailing Address - Country:US
Mailing Address - Phone:203-758-0317
Mailing Address - Fax:
Practice Address - Street 1:133 SCOVILL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-575-1811
Practice Address - Fax:203-575-1995
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000293367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTMP1465081OtherDEA