Individual
JENNIFER LYNNE WALZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
20 YORK ST, NEW HAVEN, CT 06510-3220
(203) 785-4851
Mailing address
300 GEORGE ST, 601, NEW HAVEN, CT 06511-6624
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000918
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090918
CONNECTICARE
CT
01
—
290000918CT07
ANTHEM BCBS
CT
01
—
2V9257
HEALTHNET
CT
Enumeration date
11/16/2005
Last updated
12/05/2011
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