Healthcare Provider Details

I. General information

NPI: 1164408159
Provider Name (Legal Business Name): SUZANN PATRICIA GRAVIUS C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANN P MURPHY C.R.N.A.

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WESTCHESTER AVE # 511
RYE BROOK NY
10573-1354
US

IV. Provider business mailing address

7 HENRY ST
ORANGEBURG NY
10962-2306
US

V. Phone/Fax

Practice location:
  • Phone: 914-428-5354
  • Fax:
Mailing address:
  • Phone: 845-613-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number477871-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: