Organization
PRACTITIONER SUPPORT SERVICES LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID V PENRY NP-C (PRESIDENT)
(203) 518-2124
Entity
Organization
Contact information
Practice address
324 ELM ST STE 202B, MONROE, CT 06468-2284
(203) 518-2124
Mailing address
PO BOX 4058, MONROE, CT 06468-9998
(203) 518-2124
(888) 496-0267
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004248870
—
CT
Enumeration date
10/09/2007
Last updated
06/01/2016
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