Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 005502 | CT |
NPI | 1043646268 |
---|---|
Provider Name | Diane Kay Bowler |
First Address | Danbury, CT 06810-6099 |
Second Address | Danbury, CT 06810-6099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2013 |
Last Update Date | 19/09/2013 |