Provider Demographics
NPI:1154500189
Name:HUBERTY, SUSANNE TIGHE (NP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:TIGHE
Last Name:HUBERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MCGREGOR ST FL 4
Mailing Address - Street 2:DARTMOUTH HITCHCOCK NORRIS COTTON CANCER CENTER
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3765
Mailing Address - Country:US
Mailing Address - Phone:603-629-1828
Mailing Address - Fax:
Practice Address - Street 1:87 MCGREGOR ST FL 4
Practice Address - Street 2:DARTMOUTH HITCHCOCK NORRIS COTTON CANCER CENTER
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3765
Practice Address - Country:US
Practice Address - Phone:603-629-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252353363LF0000X
NH070479-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily