=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104689397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALECIA ANTOINETTE SWABY GRIER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2024
-----------------------------------------------------
Last Update Date | 07/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 HAWKINS ST
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06418-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-522-8931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 HAWKINS ST
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06418-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-522-8931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 12910
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 135791
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------