Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN205674 | MA |
NPI | 1003215138 |
---|---|
Provider Name | Susan Raymond Marcoulier |
First Address | Sterling, MA 01564-2237 |
Second Address | Leominster, MA 01453-5507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2014 |
Last Update Date | 14/08/2014 |