Provider Demographics
NPI:1215426481
Name:PETERS, SEANA (APRN)
Entity type:Individual
Prefix:
First Name:SEANA
Middle Name:
Last Name:PETERS
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 1:10 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1828
Mailing Address - Country:US
Mailing Address - Phone:860-956-1064
Mailing Address - Fax:
Practice Address - Street 1:270 FARMINGTON AVE STE 309
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1953
Practice Address - Country:US
Practice Address - Phone:860-677-5570
Practice Address - Fax:860-677-9570
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7515363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health