Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | . | CT |
NPI | 1033627872 |
---|---|
Provider Name | Kelly Julia Nolin |
First Address | Rocky Hill, CT 06067-2313 |
Second Address | Enfield, CT 06082-3889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2018 |
Last Update Date | 15/01/2018 |