Provider Demographics
NPI:1962029660
Name:MOLKENTHIN, BRITTANY ATHENA
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ATHENA
Last Name:MOLKENTHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MERROW RD STE 3915
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3915
Mailing Address - Country:US
Mailing Address - Phone:860-875-9856
Mailing Address - Fax:860-875-9868
Practice Address - Street 1:231 MERROW RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3915
Practice Address - Country:US
Practice Address - Phone:860-875-9856
Practice Address - Fax:860-875-9868
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT142684163WP0200X
CT9537363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics