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MARY BOSS WITHEY APRN

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1255768628

Individual Registrant:
 MARY BOSS WITHEY APRN
Gender: F
Not Sole Proprietor

Location and contact information for practice:
141 TUCKIE RD  NORTH WINDHAM, CT 06256-1317 US
Tel: 860-465-2610  Fax: --

Contact information for business:
112 MANSFIELD AVE  WILLIMANTIC, CT 06226-2045 US
Tel: 860-456-9116  Fax: --

Registration Information:
NPI: 1255768628
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
CT001190

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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