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Contact Information

KRISTIN M DETLEFSEN, PA-C
100 HITCHCOCK WAY
MANCHESTER, NH03104-4125
 Phone: 603-695-2500
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KRISTIN M DETLEFSEN · (Female)

NPI # 1457436354
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 10/26/2006
Last updated 06/23/2014 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • NH License # 0604
  • NH Medicaid 30336099
  • NH Medicaid 3076097
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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