Provider Demographics
NPI:1982790580
Name:PERRONE-GRAY, ELIZABETH R (APRN, CPNP, MSN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:PERRONE-GRAY
Suffix:
Gender:F
Credentials:APRN, CPNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2918
Mailing Address - Country:US
Mailing Address - Phone:203-481-7008
Mailing Address - Fax:203-315-2712
Practice Address - Street 1:784 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2918
Practice Address - Country:US
Practice Address - Phone:203-481-7008
Practice Address - Fax:203-315-2712
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002874363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004255304Medicaid