Healthcare Provider Details

I. General information

NPI: 1992220925
Provider Name (Legal Business Name): KRISTEN JOANNE FONTAINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 04/25/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 SILAS DEANE HWY
WETHERSFIELD CT
06109-4362
US

IV. Provider business mailing address

2110 SILAS DEANE HWY
ROCKY HILL CT
06067-2353
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-6647
  • Fax:
Mailing address:
  • Phone: 860-258-3480
  • Fax: 860-571-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number007082
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: