Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 155975 | MA |
NPI | 1023225125 |
---|---|
Provider Name | Ms. Susan Jean Perry |
First Address | Fairhaven, MA 02719-5255 |
Second Address | Fall River, MA 02720-3703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 14/10/2020 |