Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382007 | NY |
NPI | 1023257714 |
---|---|
Provider Name | Mrs. Carey Reynholds Driscoll |
First Address | Farmington, CT 06032 |
Second Address | Farmington, CT 06032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2009 |
Last Update Date | 30/10/2017 |