Provider Demographics
NPI:1255306874
Name:NORGANG, SUZANNE B (CNM)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:B
Last Name:NORGANG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614
Mailing Address - Country:US
Mailing Address - Phone:207-374-3940
Mailing Address - Fax:207-374-3980
Practice Address - Street 1:57 WATER ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-3940
Practice Address - Fax:207-374-3980
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM82084367A00000X
PAMW010115367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1255306874Medicaid
PA1014969780001Medicaid
ME433089099OtherMEDICAID - BHMH
PAGU039794OtherPA MEDICARE GROUP
ME000792301OtherMED B - PERS
PAGU039794OtherPA MEDICARE GROUP
ME00792303Medicare PIN
ME000792304Medicare PIN