Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 12.004691 | CT |
NPI | 1124316419 |
---|---|
Provider Name | Christine M Raymond |
First Address | New Milford, CT 06776-5126 |
Second Address | Farmington, CT 06030-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 25/06/2021 |