Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 003402 | CT |
NPI | 1518080175 |
---|---|
Provider Name | Linda Dalessio |
First Address | New Britain, CT 06052-2016 |
Second Address | New Britain, CT 06052-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 19/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LIC | 003402 (01) | CT |