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Individual

ELISE MARIAM SAGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PNP

Contact information

Practice address
869 FORBES ST, EAST HARTFORD, CT 06118-1958
(860) 622-5343
Mailing address
80 PHOENIX AVE 201, WATERBURY, CT 06702-1418
(203) 756-8021
(203) 596-9038

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10.107616
CT
363LP0200X
Pediatric Nurse Practitioner
005079
CT
363LP0200X
Pediatric Nurse Practitioner
Primary
12.005079
CT
363LP0200X
Pediatric Nurse Practitioner
2268080
MA

Other

Enumeration date
09/23/2011
Last updated
07/30/2015
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