Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 67547 | CT |
NPI | 1023053485 |
---|---|
Provider Name | Dr. Kertrisa R Mcwhite |
First Address | Middletown, CT 06457-3654 |
Second Address | Middletown, CT 06457-4760 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 04/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008101457 | (05) | CT |
204295 | (05) | AL |
8708239 | CIGNA (01) | AL |
I52234 | (02) | |
Z51050 | VIVA HEALTH (01) | AL |