Provider Demographics
NPI:1538337027
Name:MENGHINI, JEAN ANN (RPA-C)
Entity type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:ANN
Last Name:MENGHINI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:MENGHINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:516-356-1297
Mailing Address - Fax:
Practice Address - Street 1:35 TALCOTTVILLE RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5261
Practice Address - Country:US
Practice Address - Phone:516-356-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7758363A00000X
363A00000X
CT5880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant