Healthcare Provider Details

I. General information

NPI: 1225102387
Provider Name (Legal Business Name): SUSAN HOPE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N MAIN ST SUITE 305
WEST HARTFORD CT
06117-2515
US

IV. Provider business mailing address

345 N MAIN ST SUITE 305
WEST HARTFORD CT
06117-2515
US

V. Phone/Fax

Practice location:
  • Phone: 860-231-9759
  • Fax: 860-231-9679
Mailing address:
  • Phone: 860-231-9759
  • Fax: 860-231-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number00941
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: