Individual
PHILIP MIRACLE ENNIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
269 FARMINGTON AVE, PLAINVILLE, CT 06062-1335
(860) 655-2432
Mailing address
75 GORDON LN, EAST HARTFORD, CT 06118-2222
(860) 655-2432
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
164301
CT
363L00000X
Nurse Practitioner
Primary
14447
CT
Other
Enumeration date
11/20/2024
Last updated
02/25/2025
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