Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 000034 | CT |
NPI | 1043214604 |
---|---|
Provider Name | Ms. Katy Despot |
First Address | Trumbull, CT 06611-5343 |
Second Address | Trumbull, CT 06611-5343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 08/07/2007 |