Healthcare Provider Details

I. General information

NPI: 1245368513
Provider Name (Legal Business Name): MARY SUSAN HUNGERFORD A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BOSTON AVE
STRATFORD CT
06614-5246
US

IV. Provider business mailing address

1741 MAIN ST
STRATFORD CT
06615-6556
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3377
  • Fax:
Mailing address:
  • Phone: 203-556-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberE42847
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: