1952336893 NPI number — SUSAN E. GREY APRN

Table of content: SUSAN E. GREY APRN (NPI 1952336893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952336893 NPI number — SUSAN E. GREY APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREY
Provider First Name:
SUSAN
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREY-HIGGISON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952336893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415933
Provider Second Line Business Mailing Address:
HARTFORD HOSPITAL PROFESSIONAL SERVICES
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-5933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-545-7602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 RETREAT AVENUE
Provider Second Line Business Practice Location Address:
HARTFORD HOSPITAL PSYCHIATRY DEPT
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-7330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0807X , with the licence number:  000977 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X , with the licence number: 000977 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0809X , with the licence number: 000977 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: 000977 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7820698 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004255677 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2037373 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 400000977CT02 . This is a "ANTHEM BC/BS PROVIDER NUM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: R33694 . This is a "RN LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3602617 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 000977 . This is a "APRN LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 24692 . This is a "CONTROLLED SUBST. REGISTR" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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