Provider Demographics
NPI:1811044050
Name:GREAVES, CAROL ANN (MS, APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:GREAVES
Suffix:
Gender:F
Credentials:MS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FEDERAL RD
Mailing Address - Street 2:UNIT C-33
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2647
Mailing Address - Country:US
Mailing Address - Phone:203-740-2644
Mailing Address - Fax:203-740-7887
Practice Address - Street 1:246 FEDERAL RD
Practice Address - Street 2:UNIT C-33
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2647
Practice Address - Country:US
Practice Address - Phone:203-740-2644
Practice Address - Fax:203-740-7887
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001072363LP0808X
CTR23938163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004196285Medicaid
CT890000070Medicare PIN