Provider Demographics
NPI:1346349180
Name:CHASE, SUSAN LYNN (NP, RN, CNS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:CHASE
Suffix:
Gender:F
Credentials:NP, RN, CNS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:CHASE-SHELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2201
Mailing Address - Country:US
Mailing Address - Phone:207-419-9221
Mailing Address - Fax:
Practice Address - Street 1:14 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2201
Practice Address - Country:US
Practice Address - Phone:207-419-9221
Practice Address - Fax:207-729-0190
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN25666163W00000X
MECNP81032363LP0808X
MECNS104003364SP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432055699Medicaid
ME432055699Medicaid
MENP5258Medicare PIN
MEE400188762Medicare PIN