| NPI | 1740876556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA DEE Owner 860-798-2614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2025-09-09 |