Individual
LORI LYNN CICCONE
Active
Individual
LORI LYNN CICCONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001888
CT
363AM0700X
Medical Physician Assistant
Primary
001888
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001888
LIC
CT
Enumeration date
03/01/2007
Last updated
12/08/2023
Update your record
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