Individual
AMBER FAE WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BFA
Contact information
Practice address
280 MAIN ST # C, NEW HARTFORD, CT 06057-2748
(860) 251-9404
Mailing address
101 BURGOYNE HEIGHTS RD, NEW HARTFORD, CT 06057-2000
(860) 906-4274
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
TAT.000490
CT
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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