Provider Demographics
NPI:1639198302
Name:PAQUETTE, SUSAN M (RN-CNS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:RN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JOHNNY CAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5674
Mailing Address - Country:US
Mailing Address - Phone:401-846-1213
Mailing Address - Fax:401-324-6251
Practice Address - Street 1:127 JOHNNY CAKE HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5674
Practice Address - Country:US
Practice Address - Phone:401-846-1213
Practice Address - Fax:401-324-6251
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN27310163WP0807X
RIPPNS00074364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISP07734Medicaid