Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 10087 | CT |
NPI | 1467124693 |
---|---|
Provider Name | Desmond Talento |
First Address | New London, CT 06320-4530 |
Second Address | Norwich, CT 06360-2740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2021 |
Last Update Date | 05/01/2022 |