Basic Information
Provider Information | |||||||||
NPI: | 1437284395 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOHN | ||||||||
FirstName: | SUSAN | ||||||||
MiddleName: | B | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | F.N.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BRESSLER | ||||||||
OtherFirstName: | SUSAN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | FNP-BC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 481 GOLD STAR HWY | ||||||||
Address2: | SUITE 100 | ||||||||
City: | GROTON | ||||||||
State: | CT | ||||||||
PostalCode: | 063406702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8604468858 | ||||||||
FaxNumber: | 8604052140 | ||||||||
Practice Location | |||||||||
Address1: | 481 GOLD STAR HWY | ||||||||
Address2: | SUITE 100 | ||||||||
City: | GROTON | ||||||||
State: | CT | ||||||||
PostalCode: | 063406702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8604468858 | ||||||||
FaxNumber: | 8604052140 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/22/2007 | ||||||||
LastUpdateDate: | 06/11/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0000005975 | TN | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163WP2201X | 0000067622 | TN | N |   | Nursing Service Providers | Registered Nurse | Ambulatory Care | 363LF0000X | 005447 | CT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.