Individual provider · Type 1 NPI
Michael Distasio
Family Nurse Practitioner · New Haven, CT
NPI number
1194580795
Active
Practice location
Yale New Haven Health, 789 Howard Avenue
New Haven, CT 06460
Mailing address
69 Carriage Path S
Milford, CT 06460-7544
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | 154019 (CT) |
| Family Nurse Practitioner Primary | 363LF0000X | 14094 (CT) |
Family Nurse Practitioner: Definition to come...
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About NPI 1194580795
Michael Distasio's National Provider Identifier is 1194580795, issued on Feb 14, 2024. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in New Haven, CT. The record was last updated on Dec 5, 2024.