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 Psychiatric/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 |