Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 001391 | CT |
NPI | 1215167747 |
---|---|
Provider Name | Stacey H Rubin |
First Address | West Hartford, CT 06107-1144 |
Second Address | West Hartford, CT 06107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2009 |
Last Update Date | 17/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215947387 | (05) | CT |