Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 002227 | CT |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 002227 | CT |
NPI | 1033262449 |
---|---|
Provider Name | Dr. Amy M. Nulsen |
First Address | Farmington, CT 06032 |
Second Address | Farmington, CT 06032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P54180 | (02) | CT |