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MISS JACQUELYN LONGACRE PHYSICIAN ASSISTANT

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1730749359

Individual Registrant:
MISS JACQUELYN  LONGACRE PHYSICIAN ASSISTANT
Gender: F
Sole Proprietor

Location and contact information for practice:
115 COOK HILL RD  GRISWOLD, CT 06351-3610 US
Tel: 860-861-0279  Fax: --

Contact information for business:
115 COOK HILL RD  GRISWOLD, CT 06351-3610 US
Tel: --  Fax: --

Registration Information:
NPI: 1730749359
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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