Provider Demographics
NPI:1962455436
Name:ZITELLO, SUSAN GRIFFITH (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GRIFFITH
Last Name:ZITELLO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PEMBROKE DR
Mailing Address - Street 2:BUILDING C
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6201
Mailing Address - Country:US
Mailing Address - Phone:843-682-2345
Mailing Address - Fax:843-682-2343
Practice Address - Street 1:222 PEMBROKE DR
Practice Address - Street 2:BUILDING C
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6201
Practice Address - Country:US
Practice Address - Phone:843-682-2345
Practice Address - Fax:843-682-2343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR73891367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0754Medicaid
SCAN0754Medicaid
SCQ31746Medicare UPIN