Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 004075 | CT |
NPI | 1013140540 |
---|---|
Provider Name | Deborah L Collins-Perrica |
First Address | Avon, CT 06001-2097 |
Second Address | Avon, CT 06001-2097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 01/09/2009 |