| Doctor Name: | MRS. SUSAN H. RODERICK |
| NPI Number: | 1518022045 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CFNP |
| License Number: | MA113351 |
| Business Practice Address: | 49 Harry Kemp Way Outer Cape Health Provincetown, MA - 026571618 |
| Business Phone Number: | 5084879395 |
| Business Fax Number: | 5084873285 |
| Mailing Address: | Po Box 1413, WELLFLEET |
| State: | MA |
| Postal Code: | 02667 |
| Phone Number: | 5082400208 |
| Fax Number: | 5082400499 |
| NPI Enumeration Date: | 12/26/2006 |
| NPI Last Update Date: | 12/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | MA113351 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |