Provider Demographics
NPI:1821122698
Name:MOLDE, SUSAN (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MOLDE
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 1:394 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2250
Mailing Address - Country:US
Mailing Address - Phone:203-389-1696
Mailing Address - Fax:
Practice Address - Street 1:40 ALBERT ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1542
Practice Address - Country:US
Practice Address - Phone:203-865-0068
Practice Address - Fax:203-865-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001232363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health