| NPI | 1598239758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA HAUT Provider 860-618-5455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2019-01-21 |