Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 001470 | CT |
NPI | 1588785356 |
---|---|
Provider Name | Dr. Kimberly Ann Embry |
First Address | Monroe, CT 06468-2706 |
Second Address | Monroe, CT 06468-2280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050001470CT01 | BCBS PROVIDER ID (01) | CT |