Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 047916 | CT |
N | 208600000X | Surgeon | 047916 | CT |
Y | 2086S0102X | Surgical Critical Care | 047916 | CT |
NPI | 1194963462 |
---|---|
Provider Name | Marissa Defreese |
First Address | Stamford, CT 06902-2419 |
Second Address | Stamford, CT 06902-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 07/02/2017 |