Provider Demographics
NPI:1760502397
Name:STEHLE, KRISTEN MARIA (APRN)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MARIA
Last Name:STEHLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W MYSTIC AVE # 69
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06388-9992
Mailing Address - Country:US
Mailing Address - Phone:860-245-9689
Mailing Address - Fax:
Practice Address - Street 1:55 W MYSTIC AVE # 69
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06388-9992
Practice Address - Country:US
Practice Address - Phone:860-245-9689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3582363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003582OtherLICENSE