Provider Demographics
NPI:1457467177
Name:RAVENSCROFT, ANNE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:RAVENSCROFT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:DELSANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:255 HEMPSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 GRANITE ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5730
Practice Address - Country:US
Practice Address - Phone:860-437-4555
Practice Address - Fax:860-437-4552
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003929363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008015372Medicaid