Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife |
NPI | 1144711714 |
---|---|
Provider Name | Alexis Kyra Warren |
First Address | Windsor, CT 06095-2912 |
Second Address | South Windsor, CT 06074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2018 |
Last Update Date | 12/07/2018 |