Healthcare Provider Details

I. General information

NPI: 1336169549
Provider Name (Legal Business Name): SUSAN C. BROUGHTON APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTH SECOND ST
NEW BEDFORD MA
02740
US

IV. Provider business mailing address

151 ROCK ST
FALL RIVER MA
02720-3201
US

V. Phone/Fax

Practice location:
  • Phone: 508-993-1377
  • Fax: 508-999-7795
Mailing address:
  • Phone: 508-678-7542
  • Fax: 508-676-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number121578
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: