Provider Demographics
NPI: | 1467415661 |
---|---|
Name: | D'ANNA, SUSAN P (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | SUSAN |
Middle Name: | P |
Last Name: | D'ANNA |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1 MEDICAL CENTER DR |
Mailing Address - Street 2: | |
Mailing Address - City: | LEBANON |
Mailing Address - State: | NH |
Mailing Address - Zip Code: | 03756-1000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 603-650-7840 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 MEDICAL CENTER DR |
Practice Address - Street 2: | |
Practice Address - City: | LEBANON |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03756-1000 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-650-7840 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-10 |
Last Update Date: | 2011-01-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VT | 101-0017254 | 363LA2200X |
NH | 040381-23 | 363LA2200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
783086 | Other | MVP | |
VT | 0NP0815 | Medicaid | |
VT | 28604 | Other | BCBS |
8607536 | Other | CIGNA | |
VT | 28604 | Other | BCBS |
783086 | Other | MVP | |
NP4809 | Medicare ID - Type Unspecified |