Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 029762 | CT |
NPI | 1093711954 |
---|---|
Provider Name | Beth E Nelson |
First Address | Hartford, CT 06105-1719 |
Second Address | Hartford, CT 06105-1719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 19/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00129762 | (05) | CT |
D86986 | (02) | CT |