Individual
KIMBERLY L BELLAVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS
Contact information
Practice address
114 WOODLAND ST, SURGERY DEPT., HARTFORD, CT 06105-1208
(860) 714-4694
(860) 714-8096
Mailing address
1000 ASYLUM AVE, SUITE 2109A, HARTFORD, CT 06105-1770
(860) 714-6581
(860) 714-8311
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2714
CT
Other
Enumeration date
01/09/2012
Last updated
02/13/2012
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