Provider Demographics
NPI:1023025772
Name:AUSTEN, SUSAN H (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:H
Last Name:AUSTEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:H
Other - Last Name:HENNINGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 HUNTING RIDGE FARMS
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3128
Mailing Address - Country:US
Mailing Address - Phone:203-481-5800
Mailing Address - Fax:208-481-2814
Practice Address - Street 1:15 MOHEGAN AVE,
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-437-3611
Practice Address - Fax:860-437-1801
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001027363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN