Provider Demographics
NPI:1134528268
Name:NJUGUNA, SUSAN (CNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:NJUGUNA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1215
Mailing Address - Country:US
Mailing Address - Phone:435-764-0756
Mailing Address - Fax:435-764-0756
Practice Address - Street 1:10 CAYUGA RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1215
Practice Address - Country:US
Practice Address - Phone:435-764-0756
Practice Address - Fax:435-764-0756
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270726363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA85-1149614OtherIRS