Healthcare Provider Details

I. General information

NPI: 1982790580
Provider Name (Legal Business Name): ELIZABETH R PERRONE-GRAY APRN, CPNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 E MAIN ST
BRANFORD CT
06405-2918
US

IV. Provider business mailing address

784 E MAIN ST
BRANFORD CT
06405-2918
US

V. Phone/Fax

Practice location:
  • Phone: 203-481-7008
  • Fax: 203-315-2712
Mailing address:
  • Phone: 203-481-7008
  • Fax: 203-315-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number002874
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: