Provider Demographics
NPI:1598799132
Name:MEUB, SUZANNE WENTWORTH (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:WENTWORTH
Last Name:MEUB
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BEAR RUN RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-8528
Mailing Address - Country:US
Mailing Address - Phone:603-343-0615
Mailing Address - Fax:
Practice Address - Street 1:29 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3554
Practice Address - Country:US
Practice Address - Phone:207-622-4500
Practice Address - Fax:207-622-5452
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010023871363L00000X
NH0448002303363L00000X
ME101007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30343645Medicaid
VT1010023971OtherAPRN
NH0448002303OtherARNP
VT1011641Medicaid
NH30343645Medicaid
VT1011641Medicaid