Provider Demographics
NPI:1053489237
Name:COOLEY, SUZANNE LEE (MSN, RN, CS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LEE
Last Name:COOLEY
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Gender:F
Credentials:MSN, RN, CS
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Mailing Address - Street 1:34 OAK TER
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1409
Mailing Address - Country:US
Mailing Address - Phone:617-244-0235
Mailing Address - Fax:781-416-4321
Practice Address - Street 1:42 WASHINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-1803
Practice Address - Country:US
Practice Address - Phone:781-416-7317
Practice Address - Fax:781-416-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA119642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0693Medicare ID - Type Unspecified