Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | G141047 | CA |
NPI | 1104841576 |
---|---|
Provider Name | Megan Connick |
First Address | Napa, CA 94558-2921 |
Second Address | Fairfield, CA 94534-9620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 06/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205020316 | (05) | MO |
F63453 | (02) |