Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 004536 | CT |
N | 363LA2100X | Nurse Practitioner - Acute Care | 004536 | CT |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 004536 | CT |
NPI | 1619278132 |
---|---|
Provider Name | Marc Madison Choa Uyekliong |
First Address | Rocky Hill, CT 06067-2313 |
Second Address | Hartford, CT 06106-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2010 |
Last Update Date | 26/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004536 | LICENSE (01) | CT |