Provider Demographics
NPI:1548546997
Name:ORTIZ-AYALA, WALESKA (APRN)
Entity type:Individual
Prefix:
First Name:WALESKA
Middle Name:
Last Name:ORTIZ-AYALA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:WALESKA
Other - Middle Name:
Other - Last Name:ORTIZ-AYALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:503 RACEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2515
Mailing Address - Country:US
Mailing Address - Phone:203-675-5354
Mailing Address - Fax:
Practice Address - Street 1:503 RACEBROOK RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2515
Practice Address - Country:US
Practice Address - Phone:203-675-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily