Provider Demographics
NPI:1720324205
Name:HENNESSEY-POWER, SUSAN A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:HENNESSEY-POWER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:55 FRUIT ST STE 3800-3A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-724-8636
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST STE 3800-3A
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily