Healthcare Provider Details

I. General information

NPI: 1134045800
Provider Name (Legal Business Name): MAUREEN KIERNAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAUREEN BROWN KIERNAN APRN

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TIMBER LN
FAIRFIELD CT
06824-2265
US

IV. Provider business mailing address

40 TIMBER LN
FAIRFIELD CT
06824-2265
US

V. Phone/Fax

Practice location:
  • Phone: 203-247-5576
  • Fax:
Mailing address:
  • Phone: 203-247-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6745
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6745
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: