Provider Demographics
NPI:1699875187
Name:PRASINOS, ELLEN REES (APRN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:REES
Last Name:PRASINOS
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 1:18 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2840
Mailing Address - Country:US
Mailing Address - Phone:203-245-8868
Mailing Address - Fax:203-245-7551
Practice Address - Street 1:105 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2674
Practice Address - Country:US
Practice Address - Phone:203-453-7445
Practice Address - Fax:203-245-7551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003132363LP0808X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics