PHILIP MIRACLE ENNIN

PLAINVILLE, CT
NPI1124843503
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: CT  14447)
Additional Taxonomies163W00000X Registered Nurse
(Licence: CT  164301)
Enumeration Date2024-11-20
Last Update Date2025-02-25
Business Address
PHILIP MIRACLE ENNIN APRN
269 FARMINGTON AVE
PLAINVILLE, CT 06062-1335
Phone number: 860-655-2432
Mailing Address
PHILIP MIRACLE ENNIN APRN
75 GORDON LN
EAST HARTFORD, CT 06118-2222
Phone number: 860-655-2432