Provider Demographics
NPI:1386621456
Name:VASSAR, EDITH K (APRN)
Entity type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:K
Last Name:VASSAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:KAMMERMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:52 PECK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6107
Practice Address - Country:US
Practice Address - Phone:860-482-8408
Practice Address - Fax:860-489-1206
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002241363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V2529OtherHEALTH NET
P05801Medicare UPIN
CT002241OtherCT
CT400002241CT01OtherBC BS