Provider Demographics
NPI:1376008706
Name:WOJEWUDSKI, KRISTEN ROSE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ROSE
Last Name:WOJEWUDSKI
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-8063
Mailing Address - Country:US
Mailing Address - Phone:860-679-8080
Mailing Address - Fax:860-679-1430
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-8063
Practice Address - Country:US
Practice Address - Phone:860-679-8080
Practice Address - Fax:860-679-1430
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN363LA2100X
RIAPRN02003363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIXXXXXXMedicaid