Wallis, Kristen S
Wallis, Kristen S is an individual health care provider with primary practice located at 299 Washington Ave , Hamden CT 06518-3026. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Wallis, Kristen S can be contacted via phone (203) 288-4288.Contact Information
Primary practice address
299 Washington Ave
Hamden CT 06518-3026
Phone: (203) 288-4288
Fax: (855) 414-4010
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 244100 | New York |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 046513 | Connecticut |
Profile Details
| NPI number | 1568662492 |
|---|---|
| LBN Legal business name | Wallis, Kristen S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2007 |
| Last updated | Apr 30th, 2021 - about 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568662492 | NPPES |
| Connecticut | MEDICAID | 02896880 |
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