Provider Demographics
NPI:1144502386
Name:PERUTA, COLLEEN MARY (APRN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:PERUTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MERIDEN WATERBURY TPKE
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4156
Mailing Address - Country:US
Mailing Address - Phone:860-621-2673
Mailing Address - Fax:
Practice Address - Street 1:825 MERIDEN WATERBURY TPKE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4156
Practice Address - Country:US
Practice Address - Phone:860-621-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4790363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health