Individual
MILLICENT M MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
520 SAYBROOK RD, SUITE N100, MIDDLETOWN, CT 06457-4700
(860) 344-1801
(860) 358-8657
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-8661
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
002258
CT
363LF0000X
Family Nurse Practitioner
002258
CT
363LG0600X
Gerontology Nurse Practitioner
002258
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004208296
—
CT
05
—
4208296
—
CT
Enumeration date
11/01/2006
Last updated
04/12/2017
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