Healthcare Provider Details

I. General information

NPI: 1548395015
Provider Name (Legal Business Name): SUSAN WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN E JOHNSON APRN

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WRIGHT ST
PALMER MA
01069-1156
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-284-5285
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number174113
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number174113
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: