Provider Demographics
NPI:1457805475
Name:MABKHOUTI, SALOUA (APRN)
Entity Type:Individual
Prefix:
First Name:SALOUA
Middle Name:
Last Name:MABKHOUTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 STRAITS TPKE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1836
Mailing Address - Country:US
Mailing Address - Phone:320-357-3951
Mailing Address - Fax:320-357-5520
Practice Address - Street 1:40 MAIN ST N
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-2966
Practice Address - Country:US
Practice Address - Phone:203-266-0080
Practice Address - Fax:203-575-5221
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT006607363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner