Detlefsen, Kristin Michele

Detlefsen, Kristin Michele is an individual health care provider with primary practice located at 100 Hitchcock Way , Manchester NH 03104-4125. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Detlefsen, Kristin Michele can be contacted via phone (603) 695-2500.

Contact Information

Primary practice address
100 Hitchcock Way Manchester NH 03104-4125
Phone: (603) 695-2500
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 0604 New Hampshire
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 0604 New Hampshire

Profile Details

NPI number 1457436354
LBN Legal business name Detlefsen, Kristin Michele
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 26th, 2006
Last updated Jun 23rd, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457436354 NPPES
New Hampshire MEDICAID 3076097
New Hampshire MEDICAID 30336099

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