Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | D85949 | MD |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 067620 | CT |
NPI | 1063824407 |
---|---|
Provider Name | Nicole Gavin |
First Address | Farmington, CT 06030-8085 |
Second Address | Farmington, CT 06030-8085 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 12/08/2021 |