Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 002373 | CT |
NPI | 1003996273 |
---|---|
Provider Name | Mrs. Suzanne Taylor Thompson |
First Address | Goshen, CT 06756-1813 |
Second Address | Sharon, CT 06069-2096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356318091 | (05) | CT |