Provider Demographics
NPI:1184775934
Name:RICHARDSON, SUSAN JEAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JEAN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:JEAN
Other - Last Name:WESCOAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:464 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4839
Mailing Address - Country:US
Mailing Address - Phone:508-879-3941
Mailing Address - Fax:
Practice Address - Street 1:354 WAVERLY ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7079
Practice Address - Country:US
Practice Address - Phone:508-661-2020
Practice Address - Fax:508-661-2024
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202345163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0773Medicare ID - Type Unspecified