Provider Demographics
NPI:1669528618
Name:GRAMMATICO, SUSAN N (RN, APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:N
Last Name:GRAMMATICO
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3507
Mailing Address - Country:US
Mailing Address - Phone:860-355-4113
Mailing Address - Fax:860-350-4271
Practice Address - Street 1:41 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3507
Practice Address - Country:US
Practice Address - Phone:860-355-4113
Practice Address - Fax:860-350-4271
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
400002547CT01OtherBLUE CROSS BLUE SHIELD
102547OtherCONNECTICARE
038868OtherHEALTHNET
102547OtherCONNECTICARE
400002547CT01OtherBLUE CROSS BLUE SHIELD