Provider Demographics
NPI:1437394335
Name:MOORE, SUSAN (APRN/RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN/RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WHITFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3429
Mailing Address - Country:US
Mailing Address - Phone:203-453-8553
Mailing Address - Fax:
Practice Address - Street 1:99 WHITFIELD ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-3429
Practice Address - Country:US
Practice Address - Phone:203-453-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000792364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult