| NPI | 1629593678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HANLON VAN RYE Owner 860-892-8012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 002779) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2017-08-11 |