Individual
LISAN DO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
20 BELROSE AVE, SOUTHINGTON, CT 06489-3602
(203) 788-5280
Mailing address
20 BELROSE AVE, SOUTHINGTON, CT 06489-3602
(203) 788-5280
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5845
CT
363LG0600X
Gerontology Nurse Practitioner
5845
CT
Other
Enumeration date
08/17/2014
Last updated
08/17/2014
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