Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 002322 | CT |
NPI | 1003048869 |
---|---|
Provider Name | Audrey P Senior |
First Address | New Haven, CT 06510-3220 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 12/08/2009 |