| Doctor Name: | MR. EVEROL M ENNIS |
| NPI Number: | 1205069614 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN |
| License Number: | 004168 |
| Business Practice Address: | 400 Capital Blvd Suite 3-134 Rocky Hill, CT - 060673576 |
| Business Phone Number: | 8602271343 |
| Business Fax Number: | |
| Mailing Address: | 196 Woodland Dr, CHESHIRE |
| State: | CT |
| Postal Code: | 064101645 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/01/2009 |
| NPI Last Update Date: | 05/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 004168 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |