Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1857 | CT |
NPI | 1073826533 |
---|---|
Provider Name | Dr. Tianne A Pape |
First Address | East Lyme, CT 06333-0944 |
Second Address | East Lyme, CT 06333-1743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 17/04/2017 |