Basic Information
| Provider Information | |||||||||
| NPI: | 1538208368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELTZER | ||||||||
| FirstName: | NADINE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 MIDDLE RIDGE | ||||||||
| Address2: | |||||||||
| City: | NEW CANAAN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039661188 | ||||||||
| FaxNumber: | 2033262990 | ||||||||
| Practice Location | |||||||||
| Address1: | 587 ELM STREET | ||||||||
| Address2: | ST JOSEPH FAMILY LIFE CENTER | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033262986 | ||||||||
| FaxNumber: | 2033262990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | CT001089 | CT | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | CT001089 | CT | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | MS0147632 | 01 | CT | DEA | OTHER |