| NPI | 1285816314 |
|---|---|
| Doing Business As | NURSE PRACTITIONER |
| Entity Type | Organization |
| Authorized Contact | BETH WILCOX Practice Administrator 860-443-0305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 001296) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |