Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 7645 | CT |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 7645 | CT |
NPI | 1144710955 |
---|---|
Provider Name | Jessica A Kelly-Hauser |
First Address | New Haven, CT 06510-3220 |
Second Address | New Haven, CT 06510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2018 |
Last Update Date | 29/07/2019 |