Healthcare Provider Details

I. General information

NPI: 1396775276
Provider Name (Legal Business Name): SUSAN KATHRYN CAMBRIA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 BROADVIEW RD
ORANGE CT
06477-2167
US

IV. Provider business mailing address

576 BROADVIEW RD
ORANGE CT
06477-2167
US

V. Phone/Fax

Practice location:
  • Phone: 203-876-0575
  • Fax:
Mailing address:
  • Phone: 203-876-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN000606
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: