Phanavong, Jacquelyne

Phanavong, Jacquelyne is an individual health care provider with primary practice located at 100 Grand St , New Britain CT 06052-2016. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Phanavong, Jacquelyne can be contacted via phone (860) 224-5675.

Contact Information

Primary practice address
100 Grand St New Britain CT 06052-2016
Phone: (860) 224-5675
Fax: (860) 224-5774
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 02813 Connecticut

Profile Details

NPI number 1730439597
LBN Legal business name Phanavong, Jacquelyne
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2012
Last updated Feb 15th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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