Provider Demographics
NPI:1639384555
Name:MORLEY, SUSAN J (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:MORLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:190 RIVERSIDE ST UNIT 6B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-761-6642
Practice Address - Fax:207-773-2603
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP4574Medicare ID - Type Unspecified
MEQ16162Medicare UPIN