Provider Demographics
NPI:1811183981
Name:BREI-MOELLER, AMANDA N (APRN)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:N
Last Name:BREI-MOELLER
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:PO BOX 208237
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8237
Mailing Address - Country:US
Mailing Address - Phone:203-432-0222
Mailing Address - Fax:203-432-7262
Practice Address - Street 1:55 LOCK STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-432-0222
Practice Address - Fax:203-432-7262
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304731-1363LA2200X
CT004899363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health