Provider Demographics
NPI:1649277518
Name:BROEDLIN, KRISTEN M (NP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:BROEDLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-333-8800
Mailing Address - Fax:203-333-6054
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-333-8800
Practice Address - Fax:203-333-6054
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001608363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS69944Medicare UPIN
CT500000217Medicare ID - Type Unspecified