Individual
MR. WILLIAM LANE KORNEGAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
21 MONTAUK AVE, NEW LONDON, CT 06320-4906
(860) 439-6400
(860) 390-1463
Mailing address
54 RONALD RD, GROTON, CT 06340-3819
(860) 235-6983
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
116351
CT
163WP0808X
Psychiatric/Mental Health Registered Nurse
11161
CT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2022030521
CT
Other
Enumeration date
08/16/2022
Last updated
02/06/2023
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