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General NPI Number Information
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NPI Number | 1215588009
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Entity Type | Individual
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Provider Name | MICAELA EARLE KWOCHKA PA-S
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Gender | Female
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 17 SUNRISE TER
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City | MONROE
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State | CT
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Zip | 06468-2925
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Country | US
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Telephone | 203-814-6292
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CHURCH ST S STE A230
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City | NEW HAVEN
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State | CT
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Zip | 06519-1703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4884
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License Number State | CT
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