Individual
AMANDA MARIE ANTONINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
197 FITCHVILLE RD, APT 5, BOZRAH, CT 06334-1135
(186) 028-7270
Mailing address
197 FITCHVILLE RD, APT 5, BOZRAH, CT 06334-1135
(186) 028-7270
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
6802
CT
363LG0600X
Gerontology Nurse Practitioner
6802
CT
Other
Enumeration date
02/22/2017
Last updated
02/22/2017
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