Provider Demographics
NPI:1548372816
Name:BURKHARDT, NINA FRANCES (PA)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:FRANCES
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:FRANCES
Other - Last Name:DRAFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12 VILLAGE ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3828
Mailing Address - Country:US
Mailing Address - Phone:203-777-2044
Mailing Address - Fax:203-773-3641
Practice Address - Street 1:12 VILLAGE ST
Practice Address - Street 2:SUITE 8
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3828
Practice Address - Country:US
Practice Address - Phone:203-777-2044
Practice Address - Fax:203-773-3641
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1059363A00000X
CT512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000212OtherBLUE CROSS
KS100099480AMedicaid
KS100069780FMedicaid
KSS70212Medicare UPIN
KS100099480AMedicaid
KS100099480AMedicaid
KS17-Z320Medicare ID - Type Unspecified