Individual
DONNA MARIE TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN BC
Contact information
Practice address
950 CAMPBELL AVENUE, VETERAN'S ADMINISTRATION MEDICAL CENTER, WEST HAVEN, CT 06516
(203) 932-5711
Mailing address
10 REGENT DRIVE, SHELTON, CT 06484
(203) 925-7795
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
003511
CT
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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