Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 0001768 | CT |
NPI | 1013994706 |
---|---|
Provider Name | Diane Sanchez |
First Address | Wethersfield, CT 06109-1278 |
Second Address | East Hartford, CT 06108-2292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 04/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001768 | MEDICAL LICENSE (01) | CT |
004203171 | (05) | CT |
400001768CT01 | BC/BS (01) | CT |
MS0317253 | DEA (01) | CT |
S78574 | (02) |