| NPI | 1144591595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ADEYINKA Owner 860-589-4501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 038949) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 002742) |
| Enumeration Date | 2012-01-17 |
| Last Update Date | 2012-01-17 |