Provider Demographics
NPI:1205803335
Name:KAMBE, SUSAN (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KAMBE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 OAKRIDGE
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1475
Mailing Address - Country:US
Mailing Address - Phone:860-676-0133
Mailing Address - Fax:
Practice Address - Street 1:869 FORBES ST
Practice Address - Street 2:SCHOOL BASED HEALTH CENTER
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1958
Practice Address - Country:US
Practice Address - Phone:860-622-5340
Practice Address - Fax:860-622-5342
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001541363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400001541CT19Medicare UPIN