Individual provider · Type 1 NPI

Manhouly Phouthachack

Family Nurse Practitioner · Bristol, CT

NPI number 1295965481 Active

Practice location

839 Farmington Ave
Bristol, CT 06010-3922

Mailing address

162 Washington Ave
North Haven, CT 06473-1711

Other practice locations

  • 920 2nd Ave S, Suite 400, Minneapolis, MN 55402-3318 · (612) 225-1534

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000X004098 (CT)

Family Nurse Practitioner: Definition to come...

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About NPI 1295965481

Manhouly Phouthachack's National Provider Identifier is 1295965481, issued on Jul 22, 2009. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Bristol, CT. The record was last updated on May 16, 2025.