Provider Demographics
NPI:1821348434
Name:MOLLER, SUSAN (CS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MOLLER
Suffix:
Gender:F
Credentials:CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 EAST RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03047-4407
Mailing Address - Country:US
Mailing Address - Phone:603-547-5520
Mailing Address - Fax:
Practice Address - Street 1:246 EAST RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03047-4407
Practice Address - Country:US
Practice Address - Phone:603-547-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner