Provider Demographics
NPI:1134569304
Name:LERNER, SUSAN WOLK (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WOLK
Last Name:LERNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WAVERLEY OAKS RD
Mailing Address - Street 2:DEPARTMENT OF DEVELOPMENTAL SERVICES
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8448
Mailing Address - Country:US
Mailing Address - Phone:781-314-7536
Mailing Address - Fax:
Practice Address - Street 1:411 WAVERLEY OAKS RD
Practice Address - Street 2:DEPARTMENT OF DEVELOPMENTAL SERVICES
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8448
Practice Address - Country:US
Practice Address - Phone:781-314-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN148642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily