Provider Demographics
NPI:1508099243
Name:NEAGLE, SUSAN SILVERMAN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SILVERMAN
Last Name:NEAGLE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CONNECTICUT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7303
Mailing Address - Country:US
Mailing Address - Phone:860-282-3894
Mailing Address - Fax:860-282-8582
Practice Address - Street 1:800 CONNECTICUT BOULEVARD
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-7303
Practice Address - Country:US
Practice Address - Phone:860-282-3894
Practice Address - Fax:860-282-8582
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4179363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008004592Medicaid