Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 001368 | CT |
NPI | 1073692349 |
---|---|
Provider Name | Ms. Joanne Louise Marino |
First Address | New Britain, CT 06053-2124 |
Second Address | Newington, CT 06111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |