Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 060797 | CT |
NPI | 1184945586 |
---|---|
Provider Name | Dr. Jillian Lea Fortier |
First Address | Farmington, CT 06030-0001 |
Second Address | Farmington, CT 06030-1921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2010 |
Last Update Date | 19/02/2019 |