Healthcare Provider Details

I. General information

NPI: 1245537802
Provider Name (Legal Business Name): SUSAN ANN KNOX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 STORRS ROAD NATCHAUG HOSPITAL
MANSFIELD CENTER CT
06250-0260
US

IV. Provider business mailing address

189 STORRS ROAD NATCHAUG HOSPITAL
MANSFIELD CENTER CT
06250-0260
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-1311
  • Fax: 860-423-6114
Mailing address:
  • Phone: 860-456-1311
  • Fax: 860-423-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE56993
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: