Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 008579 | CT |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP211331 | ME |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2333364 | MA |
NPI | 1023579885 |
---|---|
Provider Name | Latonya Sheriee King |
First Address | Weatogue, CT 06089-7956 |
Second Address | West Hartford, CT 06107-1957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2019 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023579885 | (05) | CT |
1023579885 | (05) | MA |