Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 18647 | CA |
Y | 363LC1500X | Nurse Practitioner - Community Health | 003907 | CT |
NPI | 1053566505 |
---|---|
Provider Name | Phuong T Le |
First Address | New Haven, CT 06515-1924 |
Second Address | East Hartford, CT 06108-3062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2008 |
Last Update Date | 12/09/2013 |