Provider Demographics
NPI:1225057318
Name:CULLEN, SUSAN IRENE (CNS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:IRENE
Last Name:CULLEN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:IRENE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4007
Mailing Address - Street 2:60 HODGES AVENUE EXT TAUNTON STATE HOSPITAL
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780
Mailing Address - Country:US
Mailing Address - Phone:508-977-3000
Mailing Address - Fax:508-977-3755
Practice Address - Street 1:60 HODGES AVE EXT
Practice Address - Street 2:TAUNTON HOSPITAL
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:508-977-3000
Practice Address - Fax:508-977-3208
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148867364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS0768Medicare ID - Type Unspecified
Q53406Medicare UPIN