Provider Demographics
NPI:1366853251
Name:EAGLESON, SUSAN V (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:V
Last Name:EAGLESON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:V
Other - Last Name:LINDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:50 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1024
Mailing Address - Country:US
Mailing Address - Phone:401-451-8670
Mailing Address - Fax:
Practice Address - Street 1:50 PARK AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1024
Practice Address - Country:US
Practice Address - Phone:401-451-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN18914163W00000X
RIPPNS00121163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163W00000XNursing Service ProvidersRegistered Nurse