Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 001935 | CT |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 001935 | CT |
NPI | 1003894734 |
---|---|
Provider Name | Ms. Maura Jane D'andrea |
First Address | Branford, CT 06405-5509 |
Second Address | Branford, CT 06405-5509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003894734 | (05) | CT |