Provider Demographics
NPI:1922873934
Name:EILERTSEN, EMILY
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:
Last Name:EILERTSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DILTHEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 GLENBROOK RD APT 407
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2873
Mailing Address - Country:US
Mailing Address - Phone:203-339-1522
Mailing Address - Fax:
Practice Address - Street 1:4697 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1869
Practice Address - Country:US
Practice Address - Phone:203-366-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife