Individual
MRS. KETANIA MARIE CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 ALBANY AVE, HARTFORD, CT 06120-2508
(860) 249-9625
Mailing address
48 COLLIER CIR, HAMDEN, CT 06518-2002
(347) 822-7285
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13544
CT
Other
Enumeration date
07/31/2024
Last updated
10/20/2024
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