Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000656 | CT |
Y | 222Z00000X | Podiatrist | 000656 | CT |
NPI | 1063412971 |
---|---|
Provider Name | Dr. Karla Renee Scanlon |
First Address | Willimantic, CT 06226-2061 |
Second Address | Willimantic, CT 06226-2061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U61683 | (02) | CT |