Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 002673 | CT |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 061910 | CT |
NPI | 1144341496 |
---|---|
Provider Name | Mrs. Polly Sather |
First Address | New Haven, CT 06511-6624 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061910 | APRN STATE LICENSE (01) | CT |