Provider Demographics
NPI:1942605860
Name:ANTHONY, SUSAN (PSS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:ME
Mailing Address - Zip Code:04735-3303
Mailing Address - Country:US
Mailing Address - Phone:207-425-2648
Mailing Address - Fax:207-425-2648
Practice Address - Street 1:525 MAIN RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:ME
Practice Address - Zip Code:04735-3303
Practice Address - Country:US
Practice Address - Phone:207-425-2648
Practice Address - Fax:207-425-2648
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECERTIFICATE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health