Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | MW00079 | RI |
NPI | 1134140098 |
---|---|
Provider Name | Andrea Young-Deciantis |
First Address | Hartford, CT 06106-1806 |
Second Address | Hartford, CT 06106-1806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 10/10/2012 |