Individual
NOUR EBID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8 DEVINE ST, NORTH HAVEN, CT 06473-2172
(877) 925-3637
Mailing address
284 ORANGE ST APT 204, NEW HAVEN, CT 06510-1705
(646) 241-2892
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
05/05/2023
Last updated
05/05/2023
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