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NPI Code Detail

MEDICARE: GABRIEL WILLIAM SUSEN AGACNP

MEDICARE: GABRIEL WILLIAM SUSEN AGACNP
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
1163W00000XRegistered NurseRN74008ME
2363LA2100XAcute Care Nurse PractitionerCNP251557ME
3163W00000XRegistered Nurse95271729CA

General Provider Information

NPI Number : 1942091178
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL WILLIAM SUSEN AGACNP
Provider Business Mailing Address
First Line : 43 WHITING HILL RD STE 300
Second Line :
City : BREWER
State : ME
Zip : 04412-1006
Country : US
Telephone Number : 207-973-5000
Fax Number : 207-973-5042
Provider Business Practice Location Address
First Line : 1 NORTHEAST DR
Second Line :
City : BANGOR
State : ME
Zip : 04401-4332
Country : US
Telephone Number : 207-275-3800
Fax Number : 207-275-3836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2025
Last Update Date : 12/22/2025

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