Individual
MR. CODY WERVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
150 LESTERTOWN RD, GROTON, CT 06340-2817
(847) 271-7404
Mailing address
150 LESTERTOWN RD, GROTON, CT 06340-2817
(847) 271-7404
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
08/06/2016
Last updated
08/06/2016
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