Provider Demographics
NPI:1639510530
Name:MURCH, SUSAN E (LAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MURCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 ALTON TANNERY RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:ME
Mailing Address - Zip Code:04468-4131
Mailing Address - Country:US
Mailing Address - Phone:207-922-7699
Mailing Address - Fax:
Practice Address - Street 1:900 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5612
Practice Address - Country:US
Practice Address - Phone:207-922-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC402171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist