HEIDI MICHELLE WALBERG (Credential# 1687749) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2020. The license expiration date date is June 30, 2021. The license status is ACTIVE.
HEIDI MICHELLE WALBERG is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004630. The credential type is physician assistant. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 105 Avon St, New Haven, CT 06511-2422. The current status is active.
| Licensee Name | HEIDI MICHELLE WALBERG |
| Credential ID | 1687749 |
| Credential Number | 23.004630 |
| Credential Type | Physician Assistant |
| Business Address |
105 Avon St New Haven CT 06511-2422 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-10-07 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-05-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1791857 | CSP.0072560 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2019-10-08 | 2019-10-08 - 2021-02-28 | ACTIVE |
| Street Address | 105 AVON ST |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06511-2422 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Robin B Goldberg | 73 Avon St, New Haven, CT 06511-2422 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Benjamin T Galen | 95 Avon St, New Haven, CT 06511-2422 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Nicole Veilleux | 97 Avon St, New Haven, CT 06511-2422 | Registered Nurse | 2018-06-01 ~ 2019-05-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Montessori School On Edgewood Inc. | 230 Edgewood Avenue, New Haven, CT 06511 | Public Charity | 2019-06-01 ~ 2020-05-31 |
| Therese Parks · Visel Drug Store | 264 Munson St, New Haven, CT 06511 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Dazjia Monet Green | 115 Edgewood Ave Apt 64, New Haven, CT 06511 | Registered Nurse | 2020-06-27 ~ 2021-05-31 |
| Carol Yam | 343 Humphrey St, New Haven, CT 06511 | Registered Nurse | ~ |
| Marwan S Haddad | 38 Lincoln Street, New Haven, CT 06511 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Mary Lou Gaeta Md | 558 Chapel Street, New Haven, CT 06511 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Cary M Tucker | 64 Bishop St, New Haven, CT 06511 | Architect | 2020-08-01 ~ 2021-07-31 |
| Frank J Pannenborg | 505 Ellsworth Ave, New Haven, CT 06511 | Architect | 2020-08-01 ~ 2021-07-31 |
| Crystal E Gooding | 26 Woodland Street, New Haven, CT 06511 | Notary Public Appointment | 2020-07-01 ~ 2025-06-30 |
| Kieran Jones | 260 Crown St Unit 1f, New Haven, CT 06511 | Registered Nurse | ~ |
| Find all Licenses in zip 06511 | |||
| City | NEW HAVEN |
| Zip Code | 06511 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + NEW HAVEN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Heidi A Courtney | 108 Circle Drive, Chicopee, MA 01020 | Physician Assistant | 1999-10-28 ~ 2000-07-31 |
| Heidi Gillespie Pa | 11032 Cottontail Ln, Parker, CO 80138-7941 | Physician Assistant | 2014-04-01 ~ 2015-03-31 |
| Heidi Dawson Stine | 442 E 78th St, New York, NY 10075 | Physician Assistant | 2019-05-01 ~ 2020-04-30 |
| Heidi L Boerman | 1313 Brown Rd, Martinsburg, WV 25404-6560 | Physician Assistant | 2019-11-01 ~ 2020-10-31 |
| Heidi W Nolan · Wiesner | 1354 Chapel Street, New Haven, CT 06511-1106 | Physician Assistant | 2019-11-01 ~ 2020-10-31 |
| Heidi Skjerdal Flicker | 11 Chapel Hill Road, Westport, CT 06880 | Physician Assistant | 2011-04-01 ~ 2012-03-31 |
| Tara Michelle Laforge | 245 5th Ave, New York, NY 10016 | Physician Assistant | ~ |
| Michelle Canning Pa | 9 Common Dr, W Hartford, CT 06107 | Physician Assistant | 2004-10-25 ~ 2005-11-30 |
| Michelle H Kwok | 169 South New Rd, Hamden, CT 06518 | Physician Assistant | 2008-06-17 ~ 2009-06-30 |
| Michelle M James | 222 E 19th St, New York, NY 10003 | Physician Assistant | 2015-02-01 ~ 2016-01-31 |
Please comment or provide details below to improve the information on HEIDI MICHELLE WALBERG.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).