Basic Information
| Provider Information | |||||||||
| NPI: | 1881887834 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LITCHFIELD COUNTY GASTROENTEROLOGY ASSOCIATES, LLC | ||||||||
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| OtherOrganizationName: | DOING BUSINESS AS NURSE PRACTITIONER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 ALVORD PARK RD | ||||||||
| Address2: | BUILDING B | ||||||||
| City: | TORRINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067903493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604960455 | ||||||||
| FaxNumber: | 8604962793 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 ALVORD PARK RD | ||||||||
| Address2: | BUILDING B | ||||||||
| City: | TORRINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067903493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604960455 | ||||||||
| FaxNumber: | 8604962793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | KIRCHER | ||||||||
| AuthorizedOfficialFirstName: | SUZAN | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8604960455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.