Provider Demographics
NPI:1003204652
Name:SANFILIPPO, GRACE MARIE CARVER
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE CARVER
Last Name:SANFILIPPO
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 1:17 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2208
Mailing Address - Country:US
Mailing Address - Phone:860-886-2461
Mailing Address - Fax:
Practice Address - Street 1:17 CASE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2208
Practice Address - Country:US
Practice Address - Phone:860-886-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692706163W00000X
NY340312363LF0000X
MARN2321628363LF0000X
CT7322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse