Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 9794 | CT |
NPI | 1639759376 |
---|---|
Provider Name | Paige Elizabeth Baccaro |
First Address | Wethersfield, CT 06109-4337 |
Second Address | New Britain, CT 06052-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2021 |
Last Update Date | 08/10/2021 |