Individual
KRISTIN MICHELE DETLEFSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 HITCHCOCK WAY, MANCHESTER, NH 03104-4125
(603) 695-2500
Mailing address
100 HITCHCOCK WAY, MANCHESTER, NH 03104-4125
(603) 695-2500
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0604
NH
363AS0400X
Surgical Physician Assistant
Primary
0604
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30336099
—
NH
05
—
3076097
—
NH
Enumeration date
10/26/2006
Last updated
06/23/2014
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