Provider Demographics
NPI:1396847075
Name:THIEVON, SUSAN LEA (MS, APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEA
Last Name:THIEVON
Suffix:
Gender:F
Credentials:MS, APRN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:LEA
Other - Last Name:CATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ARNP
Mailing Address - Street 1:1823 VT RTE 107
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:VT
Mailing Address - Zip Code:05032-9324
Mailing Address - Country:US
Mailing Address - Phone:802-234-9913
Mailing Address - Fax:
Practice Address - Street 1:1823 VT RTE 107
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:VT
Practice Address - Zip Code:05032-9324
Practice Address - Country:US
Practice Address - Phone:802-234-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH049495-23363LF0000X
NH0494952303363LP2300X
VT101.0134836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3079327Medicaid
NH30341753Medicaid
NH30341753Medicaid
NHNP3572Medicare ID - Type Unspecified