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General NPI Number Information
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NPI Number | 1558542670
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Entity Type | Individual
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Provider Name | JOHN H LALLY APRN
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Gender | Male
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 9C PASCO DR
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City | EAST WINDSOR
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State | CT
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Zip | 06088-1707
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Country | US
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Telephone | 860-490-9886
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Fax | 860-627-0400
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Provider Business Mailing Address
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Address Line | 9C PASCO DR
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City | EAST WINDSOR
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State | CT
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Zip | 06088-1707
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Country | US
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Telephone | 860-490-9886
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Fax | 860-627-0400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 003637
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License Number State | CT
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