Provider Demographics
NPI:1760502397
Name:STEHLE, KRISTEN MARIA (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIA
Last Name:STEHLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1587
Mailing Address - Country:US
Mailing Address - Phone:860-434-8847
Mailing Address - Fax:
Practice Address - Street 1:4 SHAWS CV STE 105
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4956
Practice Address - Country:US
Practice Address - Phone:860-442-1177
Practice Address - Fax:860-442-1181
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003582363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003582OtherLICENSE