Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000486 | CT |
NPI | 1093067019 |
---|---|
Provider Name | Dr. Gwenn Rosenberg |
First Address | Quaker Hill, CT 06375 |
Second Address | New London, CT 06320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2012 |
Last Update Date | 27/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12446377 | CAQH (01) | CT |