Basic Information
| Provider Information | |||||||||
| NPI: | 1003141706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRONMILLER | ||||||||
| FirstName: | SUSANNA | ||||||||
| MiddleName: | DAHL | ||||||||
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| Credential: | F.N.P, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 537 CASCADE DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068252300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853154655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5520 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | TRUMBULL | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066113463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035028400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 02/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 335939 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 7034 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 03421996 | 05 | NY | MEDICAID |