Provider Demographics
NPI:1013361641
Name:KIELTYKA, MONIKA E (FNP)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:E
Last Name:KIELTYKA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1848
Mailing Address - Country:US
Mailing Address - Phone:860-299-0100
Mailing Address - Fax:860-225-2647
Practice Address - Street 1:201 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1848
Practice Address - Country:US
Practice Address - Phone:860-229-0100
Practice Address - Fax:860-225-2647
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily