Individual
ZACHARY AUSTIN KIETZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
3 FARM GLEN BLVD, FARMINGTON, CT 06030-1285
(803) 629-4134
Mailing address
87B OLIVE ST, NEW HAVEN, CT 06511-6913
(803) 629-4134
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
209707
CT
163W00000X
Registered Nurse
RN236642
GA
363LG0600X
Gerontology Nurse Practitioner
12068
CT
363LG0600X
Gerontology Nurse Practitioner
RN236642
GA
363LP2300X
Primary Care Nurse Practitioner
Primary
12068
CT
363LP2300X
Primary Care Nurse Practitioner
RN236642
GA
Other
Enumeration date
04/17/2020
Last updated
08/20/2023
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