Healthcare Provider Details

I. General information

NPI: 1629846480
Provider Name (Legal Business Name): KIMBERLY MARIE BJELLAND CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 LOCUST AVE
DANBURY CT
06810-6032
US

IV. Provider business mailing address

2773 BLUEBIRD CIR
COSTA MESA CA
92626-4832
US

V. Phone/Fax

Practice location:
  • Phone: 203-748-6000
  • Fax:
Mailing address:
  • Phone: 714-318-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number554
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: