Provider Demographics
NPI:1679633747
Name:KAZER, MEREDITH WALLACE (PHD, APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:WALLACE
Last Name:KAZER
Suffix:
Gender:F
Credentials:PHD, APRN-BC
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Mailing Address - Street 1:842 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2246
Mailing Address - Country:US
Mailing Address - Phone:203-397-3100
Mailing Address - Fax:203-254-4126
Practice Address - Street 1:52 WASHINGTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1724
Practice Address - Country:US
Practice Address - Phone:203-672-2800
Practice Address - Fax:203-672-2801
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002766363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology