Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1569 | CT |
NPI | 1013365238 |
---|---|
Provider Name | Mrs. Erica Yorgensen |
First Address | Norwich, CT 06360-6455 |
Second Address | Norwich, CT 06360-6455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2016 |
Last Update Date | 27/05/2016 |