Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN164188 | MA |
NPI | 1013173152 |
---|---|
Provider Name | Susan Burchill |
First Address | Boston, MA 02118-2524 |
Second Address | Roslindale, MA 02131-3908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 17/03/2018 |