Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 7283 | CT |
NPI | 1023531571 |
---|---|
Provider Name | Dr. Crista C Prates |
First Address | Colchester, CT 06415-1883 |
Second Address | Norwich, CT 06360-2740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2017 |
Last Update Date | 23/10/2017 |