Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 000435 | CT |
NPI | 1750485801 |
---|---|
Provider Name | Maria Mauldon |
First Address | New Haven, CT 06515 |
Second Address | New Haven, CT 06511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004359734 | CTCXRE (01) | |
004235736 | (05) | CT |
400000435CT | ANTHEM BCBS (01) |