Individual
MISS KELLY NICOLE HAFERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
30 HAZEL ST, BRIDGEPORT, CT 06604-7752
(203) 576-4880
Mailing address
30 HAZEL ST, BRIDGEPORT, CT 06604-7752
(203) 576-4880
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/21/2021
Last updated
07/13/2021
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