Individual
MS. DIANE PACKARD ANNIBALINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
384 MERROW RD STE K, TOLLAND, CT 06084-3970
(860) 871-8851
(860) 871-8852
Mailing address
O6 SAINT MARC CIR, SOUTH WINDSOR, CT 06074-4141
(860) 682-3950
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2348
CT
363AM0700X
Medical Physician Assistant
002348
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002348
CT LICENSE NUMBER
CT
Enumeration date
02/08/2010
Last updated
03/17/2018
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