Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 003272 | CT |
NPI | 1295733954 |
---|---|
Provider Name | Ms. Kathleen M Jacobsen |
First Address | Hamden, CT 06518 |
Second Address | Branford, CT 06405-3400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295733954 | (05) | CT |