| NPI | 1821138470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE J FULLER Owner/Sole Proprietor 860-207-8160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: CT 002043) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: CT 002043) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2019-10-22 |