Provider Demographics
NPI:1265699938
Name:ROTH, SUZANNE M (MSN, APRN-BC, RNC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:ROTH
Suffix:
Gender:F
Credentials:MSN, APRN-BC, RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:110 2ND ST
Mailing Address - Street 2:PH 11
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2142
Mailing Address - Country:US
Mailing Address - Phone:617-714-3407
Mailing Address - Fax:
Practice Address - Street 1:110 2ND ST
Practice Address - Street 2:PH 11
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-2142
Practice Address - Country:US
Practice Address - Phone:617-714-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163373363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health