Provider Demographics
NPI:1588147789
Name:WROBEL, JESSIE M (APRN)
Entity type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:M
Last Name:WROBEL
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 1:270 LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4313
Mailing Address - Country:US
Mailing Address - Phone:860-617-5104
Mailing Address - Fax:
Practice Address - Street 1:8 DEVINE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2172
Practice Address - Country:US
Practice Address - Phone:203-287-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7853OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH