Provider Demographics
NPI:1881821700
Name:NWANYANWU, KRISTEN (MD, MBA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:NWANYANWU
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:227 CHURCH ST
Mailing Address - Street 2:UNIT 2C
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1817
Mailing Address - Country:US
Mailing Address - Phone:734-945-6303
Mailing Address - Fax:
Practice Address - Street 1:40 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2715
Practice Address - Country:US
Practice Address - Phone:203-785-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195314390200000X
MI4301097274390200000X
IL036132910390200000X, 207W00000X
CT54388207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program