| NPI | 1336992601 |
|---|---|
| Former Legal Business Name | SELF EMPLOYED |
| Entity Type | Organization |
| Authorized Contact | KELLI P GAGNE President 860-346-0252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-04-08 |