Provider Demographics
NPI:1801012968
Name:LEE, SUSAN RHEA
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RHEA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 NEWBURY STREET
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1723
Mailing Address - Country:US
Mailing Address - Phone:978-605-0100
Mailing Address - Fax:
Practice Address - Street 1:311 NEWBURY STREET
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1723
Practice Address - Country:US
Practice Address - Phone:978-605-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH076422-23363LF0000X
MARN228941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0707449Medicaid