Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 124491 | MA |
NPI | 1639174535 |
---|---|
Provider Name | Ms. Susan St Amour |
First Address | Fall River, MA 02720-6009 |
Second Address | Fall River, MA 02720-6009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 30/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S66208 | (02) | MA |