| NPI | 1790178366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN O. ENDERLE Sr. Vice President 860-221-0793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine |
| 207QG0300X Family Medicine Geriatric Medicine | |
| 207RG0300X Internal Medicine Geriatric Medicine | |
| 363AM0700X Physician Assistant Medical | |
| 363LA2200X Nurse Practitioner Adult Health | |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2015-06-16 |