Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 007669 | CT |
N | 363LA2100X | Nurse Practitioner - Acute Care | 12.007669 | CT |
N | 363LG0600X | Nurse Practitioner - Gerontology | 007669 | CT |
NPI | 1063998839 |
---|---|
Provider Name | Christopher Balsamo |
First Address | Hartford, CT 06102-8000 |
Second Address | Hartford, CT 06102-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 11/10/2018 |