Provider Demographics
NPI:1487641882
Name:STODDARD, ANN L (APRN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:STODDARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:KRISTINE
Other - Last Name:LINDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 425
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-548-7336
Mailing Address - Fax:860-524-2651
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 425
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-548-7336
Practice Address - Fax:860-524-2651
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR38219163W00000X
CT01334363L00000X
CT001334364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400001334CT01OtherANTHEM BCBS
CTP3367501OtherOXFORD
CT795846OtherCONNECTICARE
CT2V4118OtherHEALTH NET
CT2V4118OtherHEALTH NET