MEDICARE: MS. ELLEN STRUZZIERO RN, CNM, MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	000257	CT

General Provider Information

NPI Number	:	1639131766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN STRUZZIERO RN, CNM, MSN

Provider Business Mailing Address
First Line	:	80 PHOENIX AVE
Second Line	:	SUITE 201
City	:	WATERBURY
State	:	CT
Zip	:	06702-1418
Country	:	US
Telephone Number	:	203-756-8021
Fax Number	:	203-596-9038

Provider Business Practice Location Address
First Line	:	80 PHOENIX AVE
Second Line	:	SUITE 201
City	:	WATERBURY
State	:	CT
Zip	:	06702-1418
Country	:	US
Telephone Number	:	203-756-8021
Fax Number	:	203-596-9038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	08/27/2014

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