Individual
ELISE MAE FERNSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 W THAMES ST BLDG 301, NORWICH, CT 06360-7155
(860) 859-4563
Mailing address
122 BROOKLYN RD, POMFRET CENTER, CT 06259-2404
(860) 250-6210
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
14409
CT
Other
Enumeration date
02/27/2025
Last updated
02/27/2025
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