Individual
KRISTA DEROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
590 MIDDLEBURY RD, MIDDLEBURY, CT 06762-2562
(860) 866-7115
Mailing address
177 FRONT ST, MIDDLETOWN, CT 06457-4464
(860) 866-7115
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
128313
CT
163WM1400X
Nurse Massage Therapist (NMT)
Primary
006291
CT
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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