Healthcare Provider Details

I. General information

NPI: 1245513712
Provider Name (Legal Business Name): SUZANNE G FAITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ATTUCKS LN
HYANNIS MA
02601-1867
US

IV. Provider business mailing address

4 GREAT WESTERN ROAD
SOUTH YARMOUTH MA
02664
US

V. Phone/Fax

Practice location:
  • Phone: 508-957-0200
  • Fax: 508-957-0229
Mailing address:
  • Phone: 508-790-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN148360
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: