Individual
LISA MA PROVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
43 WOODLAND ST, HARTFORD, CT 06105-2363
(888) 793-3500
Mailing address
91 FALKNOR DR, MANCHESTER, CT 06040-2642
(860) 961-9558
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
122606
CT
Other
Enumeration date
11/05/2017
Last updated
11/05/2017
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