Provider Demographics
NPI:1922051135
Name:GRISGRABER, LINDA (APRN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:GRISGRABER
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 1:310 MAIN ST
Mailing Address - Street 2:LOWR LEVEL
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2919
Mailing Address - Country:US
Mailing Address - Phone:203-556-5225
Mailing Address - Fax:203-494-7126
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:LOWR LEVEL
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2919
Practice Address - Country:US
Practice Address - Phone:203-556-5225
Practice Address - Fax:203-494-7126
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001868363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400014272Medicare PIN
CTS64854Medicare UPIN