Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 000620 | CT |
NPI | 1023128543 |
---|---|
Provider Name | Ms. Michele V Coral |
First Address | West Haven, CT 06516-2770 |
Second Address | West Haven, CT 06516-2770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 11/07/2007 |