Provider Demographics
NPI:1598762023
Name:DOW JOHNSON, SUSAN (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DOW JOHNSON
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CANTON ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3524
Mailing Address - Country:US
Mailing Address - Phone:603-624-1638
Mailing Address - Fax:
Practice Address - Street 1:30 CANTON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3524
Practice Address - Country:US
Practice Address - Phone:603-624-1638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLNM000096367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400000096CT01OtherANTHEM
P2646485OtherOXFORD HEALTH PLANS
000096OtherCONNECTICARE
0Q2709OtherHEALTHNET