Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 028057 | CT |
NPI | 1477550036 |
---|---|
Provider Name | John C Nulsen |
First Address | Farmington, CT 06032-2568 |
Second Address | Farmington, CT 06032-2568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 01/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1280577 | (05) | CT |
B40028 | (02) | CT |