Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist | 000321 | CT |
NPI | 1780088245 |
---|---|
Provider Name | Mrs. Lisa Ann Trudeau |
First Address | Enfield, CT 06082-5501 |
Second Address | Enfield, CT 06082-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2014 |
Last Update Date | 13/10/2014 |