| NPI | 1043567647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELENA SCHJAVLAND Owner/Provider 860-245-4144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: CT 002017) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CT 002017) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2014-01-07 |