Provider Demographics
NPI:1891054490
Name:VANCE, SUZANNE MARIE (PNP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:VANCE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:275 MAMMOTH RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-663-4332
Mailing Address - Fax:603-663-3229
Practice Address - Street 1:275 MAMMOTH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-663-4332
Practice Address - Fax:603-663-3229
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA197542363LP0200X
NH060192-23363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics