| NPI | 1134274921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA LIS Billing 860-721-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 035532) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 6599) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-10-19 |