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General NPI Number Information
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NPI Number | 1134468143
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Entity Type | Organization
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Legal Business Name | GENERAL DYNAMICS
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 75 EASTERN POINT RD
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City | GROTON
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State | CT
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Zip | 06340-4905
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Country | US
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Telephone | 860-433-2043
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Fax |
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Provider Business Mailing Address
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Address Line | 75 EASTERN POINT RD
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City | GROTON
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State | CT
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Zip | 06340-4905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | NICOLE PIERRETTE ROY
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Credential | APRN
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Telephone | 860-433-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 005240
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License Number State | CT
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