| NPI | 1639220676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD CARLETON KAVLE President 860-489-5068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2017-12-07 |