Healthcare Provider Details

I. General information

NPI: 1033263470
Provider Name (Legal Business Name): SUSAN JEAN ROUSE RN,CS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN JEAN BULENS RN, CS. MS

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LINDEN PONDS WAY
HINGHAM MA
02043-3769
US

IV. Provider business mailing address

26 ARBORVIEW RD
JAMAICA PLAIN MA
02130-3419
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-7100
  • Fax: 781-534-7358
Mailing address:
  • Phone: 781-330-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number145988
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: