Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 004663 | CT |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4663 | CT |
NPI | 1033497029 |
---|---|
Provider Name | Nina S Makaridina |
First Address | New Haven, CT 06519 |
Second Address | New Haven, CT 06519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2011 |
Last Update Date | 28/06/2013 |