Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 002622 | CT |
NPI | 1003195785 |
---|---|
Provider Name | Elise Winter |
First Address | Vernon, CT 06066-5037 |
Second Address | Vernon, CT 06066-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2011 |
Last Update Date | 16/07/2014 |