Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 5427 | CT |
NPI | 1003248634 |
---|---|
Provider Name | Abigail L Klein |
First Address | Granby, CT 06035 |
Second Address | Granby, CT 06035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2013 |
Last Update Date | 29/08/2016 |