Provider Demographics
NPI:1063598316
Name:WRATCHFORD, ANN ELISA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELISA
Last Name:WRATCHFORD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 STARWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1868
Mailing Address - Country:US
Mailing Address - Phone:860-319-1444
Mailing Address - Fax:
Practice Address - Street 1:1057 POQUONNOCK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6630
Practice Address - Country:US
Practice Address - Phone:860-326-5597
Practice Address - Fax:860-326-5362
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR55783163W00000X
CT003947363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse