Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 431848 | NY |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 9426 | CT |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 9426 | CT |
NPI | 1508470238 |
---|---|
Provider Name | Kiara Goldwag |
First Address | Southbury, CT 06488-1034 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 13/08/2021 |