Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 9018 | CT |
NPI | 1013539188 |
---|---|
Provider Name | Jason Manto |
First Address | New Britain, CT 06051-1803 |
Second Address | New Britain, CT 06051-1803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2020 |
Last Update Date | 01/09/2020 |