Most Relevant Information
Provider Data
| NPI Number: | 1003321985 |
| Provider Name: | HOLLY J GUDEAHN LO |
| Entity Type: | Individual |
| Taxonomy Code: | 156FX1800X |
| Specialty: | Technician/Technologist |
| License Number: | 001763 |
Most Important Dates
| Enumeration Date: | 12/13/2017 |
| Last Updated: | 12/13/2017 |
Provider Practice Location
625 SCHOOL ST
PUTNAM
CT
062602424
Practice Location Phone/Fax
| Phone: | 8606304634 |
| Fax: | 8609284975 |
Provider Mailing Location
625 SCHOOL ST
PUTNAM
CT
062602424
Provider Mailing Phone/Fax
| Phone: | 8606304634 |
| Fax: | 8609284975 |