Organization
WEVOLVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE BUNNELL (AUTHORIZED OFFICIAL)
(475) 202-3318
Entity
Organization
Contact information
Practice address
4 CORPORATE DR STE 396, SHELTON, CT 06484-6266
(475) 202-3450
(203) 712-7130
Mailing address
4 CORPORATE DR STE 396, SHELTON, CT 06484-6266
(475) 202-3450
(203) 712-7130
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/09/2021
Last updated
02/09/2022
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