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General NPI Number Information
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NPI Number | 1619259611
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Entity Type | Individual
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Provider Name | DEVON MICHELLE KWASSMAN APRN
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Gender | Female
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 469 MIGEON AVE COMMUNITY HEALTH & WELLNESS CTR. OF GREATER TORRINGTON
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City | TORRINGTON
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State | CT
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Zip | 06790-4643
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Country | US
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Telephone | 860-489-0931
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Fax |
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Provider Business Mailing Address
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Address Line | 75 AVONWOOD RD APT A16
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City | AVON
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State | CT
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Zip | 06001-2089
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Country | US
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Telephone | 860-550-3791
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4804
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License Number State | CT
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