Healthcare Provider Details

I. General information

NPI: 1275552002
Provider Name (Legal Business Name): SUSAN LYNNE STEVENSON RNC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNION ST
WESTBOROUGH MA
01581-5408
US

IV. Provider business mailing address

5 NEPONSET ST WOT 2ND FL, STE C203
WORCESTER MA
01606-2714
US

V. Phone/Fax

Practice location:
  • Phone: 508-871-0780
  • Fax: 508-366-6744
Mailing address:
  • Phone: 508-871-0780
  • Fax: 508-366-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN141700
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: