Provider Demographics
NPI:1427301753
Name:RUSATE, MELISSA CATHERINE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CATHERINE
Last Name:RUSATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:CATHERINE
Other - Last Name:MANGINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:100 GRAND ST
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2016
Mailing Address - Country:US
Mailing Address - Phone:860-224-5501
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:PROVIDER ENROLLMENT
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5172363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health