Individual
MR. JOHN H LALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
9C PASCO DR, EAST WINDSOR, CT 06088-1707
(860) 490-9886
(860) 627-0400
Mailing address
9C PASCO DR, EAST WINDSOR, CT 06088-1707
(860) 490-9886
(860) 627-0400
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
003637
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500000024
—
CT
Enumeration date
11/16/2007
Last updated
06/05/2009
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