Provider Demographics
NPI:1477514362
Name:DUMAS, SUSAN F (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:F
Last Name:DUMAS
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:FRANCES
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:92 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4562
Mailing Address - Country:US
Mailing Address - Phone:802-773-7502
Mailing Address - Fax:802-773-7022
Practice Address - Street 1:92 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4562
Practice Address - Country:US
Practice Address - Phone:802-773-7502
Practice Address - Fax:802-773-7022
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010015655363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5501740OtherMVP
VT1008529Medicaid
VTNP509503OtherMEDICARE PTAN
Q49548Medicare UPIN
VT00049433OtherBCDS VT