Provider Demographics
NPI:1417484254
Name:DRAIGHAN, SUSANNA (APRN)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:DRAIGHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:DRAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:383 W FOUNTAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3515
Mailing Address - Country:US
Mailing Address - Phone:401-217-9377
Mailing Address - Fax:401-200-3166
Practice Address - Street 1:3 RINGGOLD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1432
Practice Address - Country:US
Practice Address - Phone:401-217-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2327944363LP0808X
RIAPRN01685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health