Individual
GRACE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, APRN
Contact information
Practice address
140 GRANDVIEW AVE, WATERBURY, CT 06708-2505
(203) 757-7000
Mailing address
111 CLOCK TOWER COMMONS, ROUTE 22, BREWSTER, NY 10509-4055
(845) 592-4919
(845) 279-5168
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
E57685
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
003750
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E57685
RN LICENCES
CT
Enumeration date
06/19/2007
Last updated
08/07/2015
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