Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 6845 | CT |
NPI | 1003359720 |
---|---|
Provider Name | Nicole Marden |
First Address | Willimantic, CT 06226-2018 |
Second Address | Danielson, CT 06239-2917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2016 |
Last Update Date | 18/01/2017 |