Provider Demographics
NPI:1730130568
Name:PHILLIPS-GRAY, SUSAN ANN (RNBC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:PHILLIPS-GRAY
Suffix:
Gender:F
Credentials:RNBC
Other - Prefix:
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Mailing Address - Street 1:61 LINCOLN STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8264
Mailing Address - Country:US
Mailing Address - Phone:508-628-0205
Mailing Address - Fax:508-626-8224
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-628-0205
Practice Address - Fax:508-626-8224
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA146722363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care