Individual
LISA M VANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1025 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4229
(860) 696-2400
(860) 696-2410
Mailing address
1025 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4229
(860) 696-2400
(860) 696-2410
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000150
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811097520
NPI
CT
Enumeration date
09/23/2006
Last updated
01/12/2010
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