Provider Demographics
NPI:1639718398
Name:GANN, SUZANNE (RN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WASHINGTON ST UNIT 2301
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2357
Mailing Address - Country:US
Mailing Address - Phone:978-943-4756
Mailing Address - Fax:
Practice Address - Street 1:3200 WASHINGTON ST UNIT 2301
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2357
Practice Address - Country:US
Practice Address - Phone:978-943-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN251542163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse