Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 027409 | CT |
N | 2080A0000X | Adolescent Medicine | 027409 | CT |
NPI | 1033178306 |
---|---|
Provider Name | Joanna Zolkowski-Wynne |
First Address | Bridgeport, CT 06610-0246 |
Second Address | Bridgeport, CT 06610-2811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F19827 | (02) | CT |