Provider Demographics
NPI:1629271333
Name:CLUETT, ANNE BRAATEN (RN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BRAATEN
Last Name:CLUETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1813
Mailing Address - Country:US
Mailing Address - Phone:631-473-8289
Mailing Address - Fax:
Practice Address - Street 1:8 LISO DR
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-1917
Practice Address - Country:US
Practice Address - Phone:631-928-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse