Provider Demographics
NPI:1760468805
Name:FOUBISTER, NICOLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:FOUBISTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1220 ASPEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-5318
Mailing Address - Country:US
Mailing Address - Phone:203-288-6086
Mailing Address - Fax:203-785-7400
Practice Address - Street 1:230 S FRONTAGE RD
Practice Address - Street 2:BOX 207900
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1124
Practice Address - Country:US
Practice Address - Phone:203-785-5050
Practice Address - Fax:203-785-7400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0426692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry