Doctor Name: | JT MOHLER-AVERY |
NPI Number: | 1013297258 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | APRN |
License Number: | 004732 |
Business Practice Address: | 520 Hartford Tpke Vernon, CT - 060665037 |
Business Phone Number: | 8608728321 |
Business Fax Number: | 8608756271 |
Mailing Address: | Po Box 3249, VERNON |
State: | CT |
Postal Code: | 060662149 |
Phone Number: | 8608722289 |
Fax Number: | 8608961425 |
NPI Enumeration Date: | 08/19/2011 |
NPI Last Update Date: | 08/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 004732 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |