Provider Demographics
NPI:1336169549
Name:BROUGHTON, SUSAN C (APRN, CNS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:APRN, CNS
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Mailing Address - Street 1:151 ROCK ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3201
Mailing Address - Country:US
Mailing Address - Phone:508-678-7542
Mailing Address - Fax:508-676-3699
Practice Address - Street 1:50 NORTH SECOND ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-993-1377
Practice Address - Fax:508-999-7795
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA121578364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0474Medicare PIN