Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 8646 | CT |
NPI | 1073143392 |
---|---|
Provider Name | Christina Marie Martin |
First Address | New Haven, CT 06511-7308 |
Second Address | Wilton, CT 06897-3018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2020 |
Last Update Date | 26/01/2020 |