MEDICARE: SUSAN JOANITTA BRATHWAITE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	255311	MA

General Provider Information

NPI Number	:	1013866243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JOANITTA BRATHWAITE RN

Provider Business Mailing Address
First Line	:	300 CHESTNUT ST STE 300
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-2427
Country	:	US
Telephone Number	:	781-559-0540
Fax Number	:	781-559-0541

Provider Business Practice Location Address
First Line	:	300 CHESTNUT ST STE 300
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-2427
Country	:	US
Telephone Number	:	781-559-0541
Fax Number	:	781-559-0540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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