Individual
MS. GWENETH M DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
675 TOWER AVE STE 301, HARTFORD, CT 06112-1274
(860) 714-8275
(860) 714-8591
Mailing address
675 TOWER AVE STE 301, HARTFORD, CT 06112-1274
(860) 714-8275
(860) 714-8591
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
7942
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7942
CT
Other
Enumeration date
03/11/2019
Last updated
06/30/2020
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