Individual
JACQUELYNE PHANAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5675
(860) 224-5774
Mailing address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5675
(860) 224-5774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
02813
CT
Other
Enumeration date
09/19/2012
Last updated
02/15/2017
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