Individual
MARYKAY BAUER WEGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2184 MAIN ST, STRATFORD, CT 06615-5937
(203) 378-9002
Mailing address
687 HERITAGE HILL RD, ORANGE, CT 06477-2497
(203) 298-4114
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
VP006124B
PA
363LA2100X
Acute Care Nurse Practitioner
003798
CT
363LF0000X
Family Nurse Practitioner
Primary
003798
CT
Other
Enumeration date
11/02/2005
Last updated
06/05/2014
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