Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 034904 | CT |
NPI | 1003889767 |
---|---|
Provider Name | Mrs. Catherine Clinton Wiley |
First Address | Hartford, CT 06106 |
Second Address | Hartford, CT 06106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004236007 | (05) | CT |
034904 | PHYSICIAN SURGEON (01) | CT |
23808 | CONTROLLED SUBSTANCE (01) | CT |
E64084 | (02) |