Individual
MS. CHARLENE ROBERTA THOMPSON CRISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15 MOHEGAN AVE, USCG ACADEMY CLINIC, NEW LONDON, CT 06320
(860) 701-6737
(860) 701-6475
Mailing address
USCG HQ CG-1121 2703 MLK JR AVE SE MAIL STOP 7907, WASHINGTON, DC 20593-7907
(202) 475-5183
(270) 294-3610
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
001831
CT
363AM0700X
Medical Physician Assistant
1710
MN
363AM0700X
Medical Physician Assistant
Primary
MP00120900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001831
PHYSICIAN ASSISTANT
CT
01
—
1051820
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
—
Enumeration date
12/22/2005
Last updated
04/29/2020
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