Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 028567 | CT |
NPI | 1003838509 |
---|---|
Provider Name | Dr. Joanne Lynn Wible-Kant |
First Address | Bridgeport, CT 06606-1805 |
Second Address | Bridgeport, CT 06606-1805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 20/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285675 | (05) | CT |
B83350 | (02) | CT |