Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 12.007185 | CT |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 7185 | CT |
NPI | 1295251254 |
---|---|
Provider Name | Mrs. Jennifer Lagosz Conboy |
First Address | West Hartford, CT 06117-1816 |
Second Address | West Hartford, CT 06107-2672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2017 |
Last Update Date | 17/10/2017 |