Provider Demographics
NPI:1205812401
Name:CONSEBIDO, PAULEEN REYES (CRNA)
Entity type:Individual
Prefix:MS
First Name:PAULEEN
Middle Name:REYES
Last Name:CONSEBIDO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HUMISTON DR
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3175
Mailing Address - Country:US
Mailing Address - Phone:203-891-5440
Mailing Address - Fax:
Practice Address - Street 1:65 HUMISTON DR
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3175
Practice Address - Country:US
Practice Address - Phone:203-891-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004081725Medicaid
CT004081725Medicaid