| NPI | 1750783619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA A CODERRE Office Manager 860-923-1181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2024-11-25 |