Provider Demographics
NPI:1245306448
Name:JAMIESON, SUSAN ANNE (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:JAMIESON
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 1:20 RESEARCH PL STE 310
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2455
Mailing Address - Country:US
Mailing Address - Phone:978-459-2152
Mailing Address - Fax:978-452-7285
Practice Address - Street 1:20 RESEARCH PL STE 310
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2455
Practice Address - Country:US
Practice Address - Phone:617-782-7788
Practice Address - Fax:617-783-5657
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182212163W00000X
MARN182212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S69496Medicare UPIN
MANP1503Medicare ID - Type Unspecified