Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 7677 | CT |
NPI | 1023513132 |
---|---|
Provider Name | Carolyn Brown |
First Address | Trumbull, CT 06611-4877 |
Second Address | Trumbull, CT 06611-4877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2018 |
Last Update Date | 01/07/2019 |