Provider Demographics
NPI:1417936790
Name:VONTELL, SUSAN (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:VONTELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:538 LITCHFIELD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-489-7017
Mailing Address - Fax:860-489-8943
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-489-7017
Practice Address - Fax:860-489-8943
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
018270OtherCONNECTICARE
CT004243333-00OtherBLUECARE FAMILY PLAN (MCD
CT400001827CT01OtherANTHEM BC/BS
0220785OtherCIGNA
CT400001827CT01OtherANTHEM BC/BS