Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | C22508 | CT |
NPI | 1902952666 |
---|---|
Provider Name | Miss Dawn Elizabeth Rosacker |
First Address | Jewett City, CT 06351-1025 |
Second Address | Norwich, CT 06360-5413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 26/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00405699-00 | BLUECARE FAMILY PLAN (01) | CT |
12DME0121CT01 | ANTHEM BLUE CROSS (01) | CT |
OR4680 | HEALTHNET (01) | CT |