Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 005039 | CT |
NPI | 1003177163 |
---|---|
Provider Name | Charis Wipfler |
First Address | Windsor, CT 06095-6190 |
Second Address | Waterbury, CT 06706-1253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2012 |
Last Update Date | 25/07/2012 |