Healthcare Provider Details

I. General information

NPI: 1962455436
Provider Name (Legal Business Name): SUSAN GRIFFITH ZITELLO C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PEMBROKE DR BUILDING C
HILTON HEAD ISLAND SC
29926-6201
US

IV. Provider business mailing address

222 PEMBROKE DR BUILDING C
HILTON HEAD ISLAND SC
29926-6201
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-2345
  • Fax: 843-682-2343
Mailing address:
  • Phone: 843-682-2345
  • Fax: 843-682-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR73891
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: