Provider Demographics
NPI:1962002691
Name:KHUEN, MARIELLE HELLERUD (FNP)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:HELLERUD
Last Name:KHUEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-2402
Mailing Address - Country:US
Mailing Address - Phone:178-145-4677
Mailing Address - Fax:
Practice Address - Street 1:39 FIFTH ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-2402
Practice Address - Country:US
Practice Address - Phone:178-145-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2020090994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily