Provider Demographics
NPI:1205054319
Name:SILJAMAKI, KARIE L (APRN)
Entity type:Individual
Prefix:
First Name:KARIE
Middle Name:L
Last Name:SILJAMAKI
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 1:2590 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5838
Mailing Address - Country:US
Mailing Address - Phone:203-377-2626
Mailing Address - Fax:203-380-2114
Practice Address - Street 1:2590 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5838
Practice Address - Country:US
Practice Address - Phone:203-377-2626
Practice Address - Fax:203-380-2114
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004268274Medicaid
CT004268274Medicaid
CT500001979Medicare PIN