| NPI | 1891749933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE IRVIN CEO 860-872-2289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 000765) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2014-05-15 |