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NPI Code Detail

MEDICARE: MS. MEREDITH WALLACE KAZER PHD, APRN-BC

MEDICARE: MS. MEREDITH WALLACE KAZER PHD, APRN-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner002766CT
2363LG0600XGerontology Nurse Practitioner002766CT

General Provider Information

NPI Number : 1679633747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MEREDITH WALLACE KAZER PHD, APRN-BC
Provider Business Mailing Address
First Line : 842 EDGEWOOD AVE
Second Line :
City : NEW HAVEN
State : CT
Zip : 06515-2246
Country : US
Telephone Number : 203-397-3100
Fax Number : 203-254-4126
Provider Business Practice Location Address
First Line : 52 WASHINGTON AVE
Second Line : SUITE 4
City : NORTH HAVEN
State : CT
Zip : 06473-1724
Country : US
Telephone Number : 203-672-2800
Fax Number : 203-672-2801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2006
Last Update Date : 04/27/2014

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