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