Healthcare Provider Details

I. General information

NPI: 1558543546
Provider Name (Legal Business Name): KRISTEN RINALDI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WOODLAND ST
HARTFORD CT
06105-2372
US

IV. Provider business mailing address

19 WOODLAND ST
HARTFORD CT
06105-2372
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-2251
  • Fax: 860-493-2552
Mailing address:
  • Phone: 860-522-2251
  • Fax: 860-493-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001997
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001997
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001997
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: