Provider Demographics
NPI:1740514884
Name:CARLISLE STEBENNE, SUZANNE (APRN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CARLISLE STEBENNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:468 ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05048-8109
Mailing Address - Country:US
Mailing Address - Phone:802-698-8028
Mailing Address - Fax:202-394-9166
Practice Address - Street 1:212 HOLIDAY DR
Practice Address - Street 2:STE 4
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-2044
Practice Address - Country:US
Practice Address - Phone:603-646-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03402623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily