Provider Demographics
NPI:1932789179
Name:PALMER, SUSAN RYAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RYAN
Last Name:PALMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1429
Mailing Address - Country:US
Mailing Address - Phone:508-735-3154
Mailing Address - Fax:
Practice Address - Street 1:11 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1429
Practice Address - Country:US
Practice Address - Phone:508-735-3154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156220RN163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care