Healthcare Provider Details

I. General information

NPI: 1144296401
Provider Name (Legal Business Name): SUSAN L BLANCHETTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE FLOOR 3
BOSTON MA
02115-5711
US

IV. Provider business mailing address

6 ALDEN RD
MILTON MA
02186-5402
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-8855
  • Fax:
Mailing address:
  • Phone: 617-698-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number155956
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WX0601X
TaxonomyOtorhinolaryngology & Head-Neck Registered Nurse
License Number155956
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: