Healthcare Provider Details

I. General information

NPI: 1679249718
Provider Name (Legal Business Name): SUSAN BABIRYE KASOZI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 CONANT ST
DANVERS MA
01923-2524
US

IV. Provider business mailing address

97 CONANT ST
DANVERS MA
01923-2524
US

V. Phone/Fax

Practice location:
  • Phone: 857-312-6804
  • Fax:
Mailing address:
  • Phone: 857-312-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2293882
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2293882
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: