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General NPI Number Information
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NPI Number | 1063598316
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Entity Type | Individual
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Provider Name | ANN ELISA WRATCHFORD PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2006
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 1057 POQUONNOCK RD SUITE 1
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City | GROTON
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State | CT
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Zip | 06340-6630
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Country | US
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Telephone | 860-326-5597
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Fax | 860-326-5362
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Provider Business Mailing Address
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Address Line | 51 STARWOOD TRL
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City | COLCHESTER
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State | CT
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Zip | 06415-1868
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Country | US
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Telephone | 860-319-1444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R55783
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 003947
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License Number State | CT
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