Organization
MILLICENT M MALCOLM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MILLICENT MARIE MALCOLM APRN (OWNER)
(860) 614-8154
Entity
Organization
Contact information
Practice address
369 BAILEYVILLE RD, MIDDLEFIELD, CT 06455
(860) 349-1116
(860) 349-1116
Mailing address
369 BAILEYVILLE RD, MIDDLEFIELD, CT 06455
(860) 349-1116
(860) 349-1116
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
002258
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004208296
—
CT
Enumeration date
02/08/2007
Last updated
11/28/2011
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