Healthcare Provider Details

I. General information

NPI: 1104885219
Provider Name (Legal Business Name): SUSAN E MUNROE R.N., B.C., F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ADAMS ST
N CHELMSFORD MA
01863-1746
US

IV. Provider business mailing address

10 ADAMS ST
N CHELMSFORD MA
01863-1746
US

V. Phone/Fax

Practice location:
  • Phone: 978-251-3159
  • Fax: 978-251-0636
Mailing address:
  • Phone: 978-251-3159
  • Fax: 978-251-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number237429
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: