Healthcare Provider Details

I. General information

NPI: 1306967864
Provider Name (Legal Business Name): SUSAN P MURTAGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN I PETRACCA NP

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 THOMPSON RD SUITE 108
WEBSTER MA
01570-1509
US

IV. Provider business mailing address

340 THOMPSON RD SUITE 108
WEBSTER MA
01570-1509
US

V. Phone/Fax

Practice location:
  • Phone: 508-943-5132
  • Fax: 508-943-5209
Mailing address:
  • Phone: 508-943-5132
  • Fax: 508-943-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number188207
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: