Healthcare Provider Details

I. General information

NPI: 1750197125
Provider Name (Legal Business Name): KRISTINE C EDWARDS APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BUSINESS PARK DR STE 202
BRANFORD CT
06405-2988
US

IV. Provider business mailing address

6 BUSINESS PARK DR STE 202
BRANFORD CT
06405-2988
US

V. Phone/Fax

Practice location:
  • Phone: 203-208-2395
  • Fax:
Mailing address:
  • Phone: 203-208-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number13946
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: