Provider Demographics
NPI:1972566271
Name:MENIHAN, SUZAN J (CNM)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:J
Last Name:MENIHAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WELLS ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2927
Mailing Address - Country:US
Mailing Address - Phone:401-348-0008
Mailing Address - Fax:401-348-3053
Practice Address - Street 1:45 WELLS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2927
Practice Address - Country:US
Practice Address - Phone:401-348-0008
Practice Address - Fax:401-348-3053
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMM0296702367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003110674Medicaid
RI7007191Medicaid
RI007058521Medicare PIN
CT420000286Medicare PIN
RI7007191Medicaid