Individual
MICHELLE SARA GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
134 STATE ST, MERIDEN, CT 06450-3293
(203) 237-2229
(203) 686-1677
Mailing address
635 MAIN ST, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
004220
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236338
—
CT
Enumeration date
08/05/2009
Last updated
01/17/2012
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