Individual
SUSAN GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1153 MAIN ST, COVENTRY, CT 06238-3115
(860) 341-2776
Mailing address
PO BOX 725, COVENTRY, CT 06238-0725
(860) 989-0035
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
002645
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002645
APRN
CT
Enumeration date
03/22/2007
Last updated
12/24/2018
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