Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 002556 | CT |
NPI | 1033189881 |
---|---|
Provider Name | Ms. Karen Jean Gregory |
First Address | Southington, CT 06489-1169 |
Second Address | Simsbury, CT 06089-9793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |