Provider Demographics
NPI:1639131766
Name:STRUZZIERO, ELLEN (RN, CNM, MSN)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:STRUZZIERO
Suffix:
Gender:F
Credentials:RN, CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PHOENIX AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1418
Mailing Address - Country:US
Mailing Address - Phone:203-756-8021
Mailing Address - Fax:203-596-9038
Practice Address - Street 1:80 PHOENIX AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1418
Practice Address - Country:US
Practice Address - Phone:203-756-8021
Practice Address - Fax:203-596-9038
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000257367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q01653Medicare UPIN
420000164Medicare ID - Type Unspecified