| NPI | 1710935002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY SIMONS Office Assistant 860-242-8756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| 363L00000X Nurse Practitioner (Licence: CT 002892) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 5854) | |
| 363L00000X Nurse Practitioner (Licence: CT 3110) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2014-11-05 |