Healthcare Provider Details

I. General information

NPI: 1083718142
Provider Name (Legal Business Name): KAREN L KLEIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 GRAND AVE FAIR HAVEN COMMUNITY HEALTH CENTER
NEW HAVEN CT
06513
US

IV. Provider business mailing address

40 ELMWOOD RD
NEW HAVEN CT
06515
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax: 203-777-8506
Mailing address:
  • Phone: 203-389-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number001235
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: