Doctor Name: | DR. MICHAEL NANNA |
NPI Number: | 1144595372 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 950 Campbell Ave Firm A Clinic West Haven, CT - 065162770 |
Business Phone Number: | 2039374767 |
Business Fax Number: | |
Mailing Address: | 950 Campbell Ave, Firm A Clinic WEST HAVEN |
State: | CT |
Postal Code: | 065162770 |
Phone Number: | 9148432188 |
Fax Number: | |
NPI Enumeration Date: | 03/21/2012 |
NPI Last Update Date: | 04/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |