Provider Demographics
NPI:1083185060
Name:DUJON, NICOLE-CHRISTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE-CHRISTIN
Middle Name:
Last Name:DUJON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE-CHRISTIN
Other - Middle Name:
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 CAROL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1204
Mailing Address - Country:US
Mailing Address - Phone:860-986-3252
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
14379663OtherCAQH