Provider Demographics
NPI:1477936847
Name:BRODEUR, SUSAN A (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BRODEUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WEED RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2724
Mailing Address - Country:US
Mailing Address - Phone:802-871-0246
Mailing Address - Fax:802-332-3117
Practice Address - Street 1:44 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2099
Practice Address - Country:US
Practice Address - Phone:802-578-8521
Practice Address - Fax:802-847-2965
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031295363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant