Individual
MS. ALLYSSA BAUCOM GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 688-2000
Mailing address
123 YORK ST APT 21C, NEW HAVEN, CT 06511-5640
(203) 393-5325
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
004548
CT
Other
Enumeration date
01/16/2011
Last updated
01/16/2011
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