Provider Demographics
NPI:1356389753
Name:HURLEY, SUSAN LYSAGHT (APRN, BC-PCM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYSAGHT
Last Name:HURLEY
Suffix:
Gender:F
Credentials:APRN, BC-PCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81 HIGHLAND AVE
Mailing Address - Street 2:NORTH SHORE MEDICAL CENTER
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-741-1200
Mailing Address - Fax:
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:NORTH SHORE MEDICAL CENTER--PALLIATIVE CARE
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2714
Practice Address - Country:US
Practice Address - Phone:978-741-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242784363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA706256Medicaid
Q29232Medicare UPIN
MA706256Medicaid