Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 8219 | CT |
NPI | 1003475278 |
---|---|
Provider Name | Milagros Arel Wong |
First Address | Waterbury, CT 06708-3236 |
Second Address | Middlebury, CT 06762-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 11/06/2019 |