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NPI Code Detail

MEDICARE: SUSAN M ELLES APRN

MEDICARE: SUSAN M ELLES APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner6318CT

General Provider Information

NPI Number : 1972976553
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M ELLES APRN
Provider Business Mailing Address
First Line : 1057 BOSTON POST RD
Second Line :
City : GUILFORD
State : CT
Zip : 06437-2644
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 1057 BOSTON POST RD
Second Line :
City : GUILFORD
State : CT
Zip : 06437-2644
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2015
Last Update Date : 08/14/2022

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