| NPI | 1780926774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN MARIE MAHAN Owner 860-892-8012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 004797) |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2022-06-17 |