Healthcare Provider Details

I. General information

NPI: 1841240587
Provider Name (Legal Business Name): SUSAN M KLOSS LANEN MSN, RN, GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 VERMONT AVE NW
WASHINGTON DC
20420-0001
US

IV. Provider business mailing address

160 N SHORE DR
STOW MA
01775-1508
US

V. Phone/Fax

Practice location:
  • Phone: 202-461-6049
  • Fax:
Mailing address:
  • Phone: 978-562-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR039620
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR039620
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: