Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 002084 | CT |
NPI | 1033127709 |
---|---|
Provider Name | Sarah Mottram Vaughan |
First Address | Hamden, CT 06517-1604 |
Second Address | New Haven, CT 06511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |