Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 342174 | NY |
NPI | 1003473489 |
---|---|
Provider Name | Mrs. Jenna Katt |
First Address | Stamford, CT 06902-5361 |
Second Address | Stamford, CT 06902-5361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |