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SUSAN CLAYTON BALLOU CPNP

Pediatrics >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1588947170

Individual Registrant:
 SUSAN CLAYTON BALLOU CPNP
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: --

Contact information for business:
3 HILLCREST PARK RD  OLD GREENWICH, CT 06870-1003 US
Tel: 203-202-7532  Fax: --

Registration Information:
NPI: 1588947170
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP0200XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Pediatrics
CT004268

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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