Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 007230 | CT |
NPI | 1013436229 |
---|---|
Provider Name | Patricia Anne Simpson |
First Address | Bridgeport, CT 06610-2805 |
Second Address | Bridgeport, CT 06610-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2017 |
Last Update Date | 02/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
026889206 | DRIVERS LICENSE (01) | CT |