Provider Demographics
NPI:1548418080
Name:PROTO, KRISTIANE N (MSN,APRN,FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIANE
Middle Name:N
Last Name:PROTO
Suffix:
Gender:F
Credentials:MSN,APRN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O NORTHEAST MEDICAL GROUP, INC.
Mailing Address - Street 2:226 MILL HILL AVE., 3RD FLOOR
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:203-259-7871
Mailing Address - Fax:203-254-2235
Practice Address - Street 1:200 ORCHARD ST
Practice Address - Street 2:SUITE 207
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5363
Practice Address - Country:US
Practice Address - Phone:203-777-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily