Healthcare Provider Details

I. General information

NPI: 1326008467
Provider Name (Legal Business Name): SUSAN LASCALA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIN STREET DEERFIELD ACADEMY HEALTH CENTER
DEERFIELD MA
01342
US

IV. Provider business mailing address

78 FRENCH KING HWY
GILL MA
01354-9718
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-1600
  • Fax:
Mailing address:
  • Phone: 413-863-2435
  • Fax: 413-863-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number170285
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: