Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 025580 | CT |
NPI | 1124001359 |
---|---|
Provider Name | Linda Kathyn Bockenstedt |
First Address | New Haven, CT 06536-0805 |
Second Address | New Haven, CT 06519-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001255801 | (05) | CT |
E39338 | (02) |