Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 402 | CT |
NPI | 1093198582 |
---|---|
Provider Name | Jennifer Love |
First Address | Manchester, CT 06040-4128 |
Second Address | Manchester, CT 06040-4128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 09/01/2017 |