Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000280 | CT |
NPI | 1104961168 |
---|---|
Provider Name | Dr. Lynnette Michelle Guida |
First Address | Middletown, CT 06457-1867 |
Second Address | Middletown, CT 06457-1867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 13/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000280 | CT NATUROPATHIC LICENSE N (01) | CT |
000321 | CT ACUPUNCTURIST LICENSE (01) | CT |
110000280CT02 | ANTHEM PROVIDER ID NUMBER (01) | CT |
691926 | CONNECTICARE PROVIDER ID (01) | CT |