Provider Demographics
NPI:1851448823
Name:GURNEY, SUSAN MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:GURNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4526
Mailing Address - Country:US
Mailing Address - Phone:207-861-3000
Mailing Address - Fax:207-861-3025
Practice Address - Street 1:200 KENNEDY MEMORIAL DR.
Practice Address - Street 2:SUITE 304 INLAND HOSPITAL
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-873-1036
Practice Address - Fax:207-873-1039
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER027885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEQ02953OtherCOMMERCIAL
ME432127699Medicaid
MEGUNP4342Medicare ID - Type UnspecifiedMEDICARE
Q02953Medicare UPIN