Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 055544 | CT |
NPI | 1053607416 |
---|---|
Provider Name | Mrs. Jurate Ivanaviciene |
First Address | Farmington, CT 06030-0001 |
Second Address | Farmington, CT 06030-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 25/07/2016 |