Individual
MANHOULY PHOUTHACHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
839 FARMINGTON AVE, BRISTOL, CT 06010-3922
(866) 389-2727
Mailing address
162 WASHINGTON AVE, NORTH HAVEN, CT 06473-1711
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
004098
CT
Other
Enumeration date
07/22/2009
Last updated
05/16/2025
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