Provider Demographics
NPI:1528653961
Name:PEDERSEN, KIRSTEN MAGDA (PA-C)
Entity type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:MAGDA
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1290 SILAS DEANE HIGHWAY
Mailing Address - Street 2:HHC - CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3112
Practice Address - Country:US
Practice Address - Phone:203-271-3296
Practice Address - Fax:203-250-7957
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2023-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT6288363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical