Andrea, Susan
Andrea, Susan is an individual health care provider with primary practice located at 111 Torrey St Suite A, Brockton MA 02301-4800. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Andrea, Susan can be contacted via phone (508) 588-1200.Contact Information
Primary practice address
111 Torrey St Suite A
Brockton MA 02301-4800
Phone: (508) 588-1200
Fax: (508) 941-0497
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 149570 | Massachusetts |
Profile Details
| NPI number | 1902966039 |
|---|---|
| LBN Legal business name | Andrea, Susan |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 11th, 2006 |
| Last updated | Nov 4th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902966039 | NPPES |
| Massachusetts | MEDICAID | 0712604 |
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