Healthcare Provider Details

I. General information

NPI: 1235012618
Provider Name (Legal Business Name): JENNIFER SUON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 CENTRAL ST
LOWELL MA
01852-1910
US

IV. Provider business mailing address

38A BROOKWOOD DR
SALEM NH
03079-3017
US

V. Phone/Fax

Practice location:
  • Phone: 978-513-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112517-21
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10012127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: