Provider Demographics
NPI:1467706010
Name:GRAZIANO, COLLEEN A (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2920
Mailing Address - Country:US
Mailing Address - Phone:860-226-4500
Mailing Address - Fax:860-226-3262
Practice Address - Street 1:900 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2920
Practice Address - Country:US
Practice Address - Phone:860-226-4500
Practice Address - Fax:860-226-3262
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5148363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1467706010Medicaid