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Individual

REBECCA L RICHARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
36 LAFAYETTE ST, NORWICH, CT 06360-3408
(860) 885-0666
(860) 885-1158
Mailing address
36 LAFAYETTE ST, NORWICH, CT 06360-3408
(860) 885-0666
(860) 885-1158

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002676
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002676
PHYSICIAN ASSISTANT LICENSE
CT
Enumeration date
12/23/2011
Last updated
01/05/2016
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