Provider Demographics
NPI:1699751099
Name:BECKER-TALWALKAR, KRISTEN (CNM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BECKER-TALWALKAR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BECKER-TALWALKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:40 TEMPLE ST.
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:203-789-2011
Mailing Address - Fax:203-458-9063
Practice Address - Street 1:40 TEMPLE ST.
Practice Address - Street 2:SUITE 7A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-789-2011
Practice Address - Fax:203-458-9063
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000247LNM367A00000X
CT064928(RN)207V00000X
CT000247(CNM)207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
024700OtherCONNECT CARE
P2832855OtherOXFORD HEALTH PLAN
4000000247CT01OtherANTHEM BLUE CROSS OF CT
OQ2713OtherHEALTH NET