Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 005123 | CT |
NPI | 1033460571 |
---|---|
Provider Name | Susan Marchitto |
First Address | West Haven, CT 06516-4861 |
Second Address | West Haven, CT 06516-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2012 |
Last Update Date | 24/09/2012 |