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SUSAN CLAYTON BALLOU CPNP
Pediatrics >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1588947170
Individual Registrant: SUSAN CLAYTON BALLOU CPNP
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
3 HILLCREST PARK RD OLD GREENWICH, CT 06870-1003 US
Tel: 203-202-7532 Fax: --
Tel: 203-202-7532 Fax: --
Contact information for business:
3 HILLCREST PARK RD OLD GREENWICH, CT 06870-1003 US
Tel: 203-202-7532 Fax: --
Tel: 203-202-7532 Fax: --
Registration Information:
NPI: 1588947170
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Pediatrics | CT | 004268 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
