Individual
MR. EDIN MEMISEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5946
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
6411
CT
363LP2300X
Primary Care Nurse Practitioner
Primary
6411
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004217099
—
CT
05
—
008056033
—
CT
05
—
008056168
—
CT
01
—
008063396
MEMISEVICH MEDICAID
CT
Enumeration date
12/15/2015
Last updated
01/09/2017
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