Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 002962 | CT |
N | 363LC1500X | Nurse Practitioner - Community Health | 002962 | CT |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 002962 | CT |
NPI | 1649281544 |
---|---|
Provider Name | Melanie Mollica |
First Address | Torrington, CT 06790-4643 |
Second Address | Torrington, CT 06790-4643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 30/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004247872 | (05) | CT |
071834 | MEDICARE (01) | |
Q02829 | (02) | CT |