1285669127 NPI number — SUSAN K PLANTE APRN

Table of content: SUSAN K PLANTE APRN (NPI 1285669127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285669127 NPI number — SUSAN K PLANTE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLANTE
Provider First Name:
SUSAN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285669127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2D
Provider Business Mailing Address City Name:
NORTH EASTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02356-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-238-7766
Provider Business Mailing Address Fax Number:
508-230-5089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
NORTH EASTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02356-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-238-7766
Provider Business Practice Location Address Fax Number:
508-230-5089
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  145823 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30066-1 . This is a "BC BS OF RHODE ISLAND" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: PN0714 . This is a "BC BS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 145823 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CP0091 . This is a "BC BS CARE 65" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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