Provider Demographics
NPI:1710145842
Name:WARGO, SUSANNE MARGARET (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:MARGARET
Last Name:WARGO
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 1:440 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-1902
Mailing Address - Country:US
Mailing Address - Phone:860-583-5858
Mailing Address - Fax:
Practice Address - Street 1:440 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-1902
Practice Address - Country:US
Practice Address - Phone:860-583-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR28909163W00000X
CT001048364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse