Provider Demographics
NPI:1851919567
Name:GRUEN, ALYSSA E (APRN)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:E
Last Name:GRUEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 CAMPBELL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3789
Mailing Address - Country:US
Mailing Address - Phone:203-889-2297
Mailing Address - Fax:203-889-2249
Practice Address - Street 1:755 CAMPBELL AVE STE 2
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3789
Practice Address - Country:US
Practice Address - Phone:038-892-2972
Practice Address - Fax:203-889-2249
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily