Basic Information
Provider Information
NPI: 1003141706
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRONMILLER
FirstName: SUSANNA
MiddleName: DAHL
NamePrefix:  
NameSuffix:  
Credential: F.N.P, APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 537 CASCADE DR
Address2:  
City: FAIRFIELD
State: CT
PostalCode: 068252300
CountryCode: US
TelephoneNumber: 5853154655
FaxNumber:  
Practice Location
Address1: 5520 PARK AVE
Address2:  
City: TRUMBULL
State: CT
PostalCode: 066113463
CountryCode: US
TelephoneNumber: 2035028400
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/14/2009
LastUpdateDate: 02/28/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X7034CTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X335939NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
0342199605NY MEDICAID


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