Granville, Kathryn

Granville, Kathryn is an individual health care provider with primary practice located at 60 Housatonic Ave , Bridgeport CT 06604-4026. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Granville, Kathryn can be contacted via phone (203) 579-6548.

Contact Information

Primary practice address
60 Housatonic Ave Bridgeport CT 06604-4026
Phone: (203) 579-6548
Fax: (203) 579-3688
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 001766 Connecticut

Profile Details

NPI number 1598743551
LBN Legal business name Granville, Kathryn
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2006
Last updated Mar 22nd, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598743551 NPPES
Connecticut Other 001766 LICENSE
Connecticut MEDICAID 004235900 LICENSE

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