Provider Demographics
NPI:1174643530
Name:PACHLER KENNELL, MARYELLEN PACHLER (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:PACHLER
Last Name:PACHLER KENNELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARYELLEN
Other - Middle Name:CREAMER
Other - Last Name:PACHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:399 EAST PUTNAM AVE.
Mailing Address - Street 2:2ND FLOOR SUITE #1
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807
Mailing Address - Country:US
Mailing Address - Phone:860-478-4134
Mailing Address - Fax:203-769-1366
Practice Address - Street 1:399 EAST PUTNAM AVE.
Practice Address - Street 2:2ND FLOOR SUITE #1
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807
Practice Address - Country:US
Practice Address - Phone:860-478-4134
Practice Address - Fax:203-769-1366
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003159363LP0200X, 363LP0808X
CTCTAPRN003159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health