Individual
MARY WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
327 HUNTINGDON AVE, WATERBURY, CT 06708-1413
(203) 757-0621
Mailing address
327 HUNTINGDON AVE, WATERBURY, CT 06708-1413
(203) 757-0621
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
CSW.0003304
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235364571
—
MI
Enumeration date
03/11/2016
Last updated
03/11/2016
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