Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 505 | CT |
NPI | 1003571159 |
---|---|
Provider Name | Jessica Louise Jones |
First Address | East Hartford, CT 06118-2827 |
Second Address | Manchester, CT 06040-4735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2021 |
Last Update Date | 03/11/2021 |