Doctor Name: | SUSAN RAYMOND MARCOULIER |
NPI Number: | 1003215138 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | AGPCNP-BC |
License Number: | RN205674 |
Business Practice Address: | 87 N Main St Leominster, MA - 014535507 |
Business Phone Number: | 9785348701 |
Business Fax Number: | |
Mailing Address: | 16 Cole Rd, STERLING |
State: | MA |
Postal Code: | 015642237 |
Phone Number: | 9787904207 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2014 |
NPI Last Update Date: | 08/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | RN205674 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |