Provider Demographics
NPI:1568513976
Name:DRAKE, SUELLEN O (APRN)
Entity Type:Individual
Prefix:
First Name:SUELLEN
Middle Name:O
Last Name:DRAKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:SUELLEN
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-0924
Mailing Address - Country:US
Mailing Address - Phone:603-608-6192
Mailing Address - Fax:603-942-8194
Practice Address - Street 1:13 JENKINS CT STE 247
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824
Practice Address - Country:US
Practice Address - Phone:603-942-5694
Practice Address - Fax:603-942-8194
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04081123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30343034Medicaid
NH30343034Medicaid
NH30343034Medicaid