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General NPI Number Information
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NPI Number | 1922578277
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Entity Type | Organization
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Legal Business Name | MICHELLE S GAUTHIER APRN, LLC
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 555 HIGHLAND AVE
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City | CHESHIRE
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State | CT
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Zip | 06410-2255
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Country | US
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Telephone | 203-848-8581
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Fax |
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Provider Business Mailing Address
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Address Line | 555 HIGHLAND AVE
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City | CHESHIRE
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State | CT
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Zip | 06410-2255
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Country | US
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Telephone | 203-651-8809
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELLE S GAUTHIER
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Credential | APRN
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Telephone | 203-651-8809
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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 |
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License Number State |
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