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General NPI Number Information
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NPI Number | 1164408159
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Entity Type | Individual
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Provider Name | SUZANN PATRICIA GRAVIUS C.R.N.A.
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Gender | Female
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 800 WESTCHESTER AVE # 511
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City | RYE BROOK
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State | NY
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Zip | 10573-1354
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Country | US
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Telephone | 914-428-5354
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Fax |
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Provider Business Mailing Address
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Address Line | 7 HENRY ST
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City | ORANGEBURG
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State | NY
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Zip | 10962-2306
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Country | US
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Telephone | 845-613-7957
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 477871-1
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License Number State | NY
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