Basic Information
| Provider Information | |||||||||
| NPI: | 1629023536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KULIKOWSKI | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MSN; CERTIFIED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 982 EAST MAIN STREET | ||||||||
| Address2: | OPTIMUS HEALTH CARE | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036963260 | ||||||||
| FaxNumber: | 2036963250 | ||||||||
| Practice Location | |||||||||
| Address1: | 982 EAST MAIN STREET | ||||||||
| Address2: | OPTIMUS HEALTH CARE | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036963260 | ||||||||
| FaxNumber: | 2036963250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 12/02/2011 | ||||||||
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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 | 367A00000X | 000003 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 176B00000X | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 000003 | 01 | CT | STATE LICENSE | OTHER |