Provider Demographics
NPI:1902831126
Name:TINGUELY, SUSAN N (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:N
Last Name:TINGUELY
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 1:111 FRANKLIN HEALTH COMMONS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6144
Mailing Address - Country:US
Mailing Address - Phone:207-778-6394
Mailing Address - Fax:207-778-2886
Practice Address - Street 1:181 FRANKLIN HEALTH COMMONS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-778-6394
Practice Address - Fax:207-778-2886
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP0307Medicare ID - Type Unspecified
MER81254Medicare UPIN