Provider Demographics
NPI:1851352850
Name:GRUEN, SUSAN M (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:GRUEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:F,NP
Mailing Address - Street 1:PO BOX 8019
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01102-8000
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:NORTHAMPTON HEALTH CENTER
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1466
Practice Address - Country:US
Practice Address - Phone:413-586-8400
Practice Address - Fax:413-585-5435
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA131025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1293396OtherFALLON
MA131025OtherCONNECTICARE, INC.
MA500016108OtherRAILROAD MEDICARE
MANP2352OtherBLUE CROSS BLUE SHIELD
MA0351491Medicaid
MANP2352Medicare PIN
MANP2352OtherBLUE CROSS BLUE SHIELD