Individual
MS. KATHRYN GRANVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
60 HOUSATONIC AVE, BRIDGEPORT, CT 06604-4026
(203) 579-6548
(203) 579-3688
Mailing address
60 HOUSATONIC AVE, BRIDGEPORT, CT 06604-4026
(203) 579-6548
(203) 579-3688
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
001766
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001766
LICENSE
CT
05
—
004235900
—
CT
Enumeration date
01/09/2006
Last updated
03/22/2022
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