Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 7489 | CT |
NPI | 1023511292 |
---|---|
Provider Name | Sofia Ashley Loran |
First Address | New Haven, CT 06519-0720 |
Second Address | New Haven, CT 06519-1233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004235900 | (05) | CT |