Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 7624 | CT |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 7624 | CT |
NPI | 1548752843 |
---|---|
Provider Name | Abigail Bingham |
First Address | Clinton, CT 06413-1931 |
Second Address | Hartford, CT 06102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 09/10/2018 |