Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 004743 | CT |
NPI | 1003199563 |
---|---|
Provider Name | Mrs. Christy A Hendrie |
First Address | Derby, CT 06418-1802 |
Second Address | Trumbull, CT 06611-2556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2011 |
Last Update Date | 02/11/2018 |