Provider Demographics
NPI:1801044656
Name:LOTH, ADRIENNE BERGE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:BERGE
Last Name:LOTH
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 1:4 RUNNING PINE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1307
Mailing Address - Country:US
Mailing Address - Phone:860-669-2792
Mailing Address - Fax:
Practice Address - Street 1:4 RUNNING PINE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1307
Practice Address - Country:US
Practice Address - Phone:860-669-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily