MATTHEW WIESE PA (Credential# 743308) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is May 23, 2005. The license expiration date date is July 31, 2006. The license status is INACTIVE.
MATTHEW WIESE PA is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.001559. The credential type is physician assistant. The effective date is May 23, 2005. The expiration date is July 31, 2006. The business address is 2200 Whitney Ave Ste 360, Hamden, CT 06518. The current status is inactive.
| Licensee Name | MATTHEW WIESE PA |
| Credential ID | 743308 |
| Credential Number | 23.001559 |
| Credential Type | Physician Assistant |
| Business Address |
2200 Whitney Ave Ste 360 Hamden CT 06518 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 2004-10-29 |
| Effective Date | 2005-05-23 |
| Expiration Date | 2006-07-31 |
| Refresh Date | 2009-07-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 387661 | CSP.0036660 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2004-11-05 | 2005-03-01 - 2006-02-28 | INACTIVE |
| Street Address | 2200 WHITNEY AVE STE 360 |
| City | HAMDEN |
| State | CT |
| Zip Code | 06518 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Anthony Capobianco Pa | 2200 Whitney Ave Ste 360, Hamden, CT 06518-3694 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Benigno Rafael Varela Guerrero | 2200 Whitney Ave Ste 360, Hamden, CT 06518-3602 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Latha Alaparthi Md | 2200 Whitney Ave Ste 360, Hamden, CT 06518 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Kate Charron Pa | 2200 Whitney Ave Ste 360, Hamden, CT 06518-3694 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Deepika Srinivasan | 2200 Whitney Ave Ste 360, Hamden, CT 06518-3602 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Kristin E Nolan | 2200 Whitney Ave Ste 360, Hamden, CT 06518-3602 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Jillian M Diviesta | 2200 Whitney Ave Ste 360, Hamden, CT 06518-3694 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Leeanne B Sherwin Aprn | 2200 Whitney Ave Ste 360, Hamden, CT 06518 | Advanced Practice Registered Nurse | 2002-08-20 ~ 2003-09-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Barbara Esposito Aprn | 209 Todd St, Hamden, CT 06518 | Advanced Practice Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Sorrentos Brick Oven Pizzeria | 244 Skiff St, Hamden, CT 06518 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Jenna Bump | 61 Cannon St, Hamden, CT 06518 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Jennifer E Pohl | 70 Norwood Avenue, Hamden, CT 06518 | Speech and Language Pathologist | 2020-07-01 ~ 2021-06-30 |
| Nicole O Miller-tyson | 648 Evergreen Ave, Hamden, CT 06518 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Nancy D Anderson | 399 Hillfield Road, Hamden, CT 06518 | Speech and Language Pathologist | 2020-08-01 ~ 2021-07-31 |
| Flowers From The Farm | 1035 Shepard Avenue, Hamden, CT 06518 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Lynda Burke | 68 Linden Avenue, Hamden, CT 06518 | Notary Public Appointment | 2011-12-08 ~ 2016-12-31 |
| Kelly Lynn Huppert | 1334 Town Walk Dr, Hamden, CT 06518 | Master's Level Social Worker | ~ |
| Robert L Engengro | 365 Forest Street, Hamden, CT 06518 | Real Estate Salesperson | 2020-06-23 ~ 2021-05-31 |
| Find all Licenses in zip 06518 | |||
| City | HAMDEN |
| Zip Code | 06518 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + HAMDEN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Melanie Lynne Rasmus | 225 Wiese Albert Rd, Higganum, CT 06441-4040 | Physician Assistant | 2018-04-01 ~ 2019-03-31 |
| Matthew W. Musco Pa-c | 132 Clearfield Rd, Wethersfield, CT 06109 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Matthew J Moore | 55 Langdon Ct, Berlin, CT 06037-1316 | Physician Assistant | 2019-02-01 ~ 2020-01-31 |
| Matthew D Nankin | 138 Fair St, Wallingford, CT 06492-4210 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Matthew Wieland | 59 Maitland Rd, Stamford, CT 06906-2104 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Matthew M Faucher | 26 Hawthorne Pl, North Andover, MA 01845-4205 | Physician Assistant | ~ |
| Matthew E. Milstein | Psc 475 Box 1315, Fpo Yokohama, 96350 | Physician Assistant | 2014-04-01 ~ 2015-03-31 |
| Matthew Champeau Pa | 234 Spielman Hwy, Burlington, CT 06013-2010 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Matthew A Bouteiller Pa | 50 Union St Apt 9, Northampton, MA 01060-3254 | Physician Assistant | 2012-11-01 ~ 2013-10-31 |
| Matthew C Singleton Pa-c | 41 Rochela Dr, Southington, CT 06489-4670 | Physician Assistant | 2016-08-01 ~ 2017-07-31 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).