Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 000755 | CT |
NPI | 1013942465 |
---|---|
Provider Name | Mrs. Nancy Lou Kline |
First Address | Woodbridge, CT 06525 |
Second Address | Waterbury, CT 06706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |