Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 000932 | CT |
NPI | 1033217237 |
---|---|
Provider Name | Patricia S Masopust |
First Address | Windham, CT 06280-0231 |
Second Address | Willimantic, CT 06226-2027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |