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Individual

GINA F LIDESTRI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
41 BREWSTER RD, BRISTOL, CT 06010-5161
(860) 585-3313
Mailing address
41 BREWSTER RD, BRISTOL, CT 06010-5161
(860) 585-3313

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001942
CT
363AM0700X
Medical Physician Assistant
Primary
001942
CT

Other

Enumeration date
08/24/2007
Last updated
01/21/2012
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