Healthcare Provider Details

I. General information

NPI: 1982753372
Provider Name (Legal Business Name): SUSAN PRESTES RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MILLBURY ST PERNET FAMILY HEALTH CENTER
WORCESTER MA
01610
US

IV. Provider business mailing address

30 INDIAN HILL RD
WORCESTER MA
01606
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-1228
  • Fax: 508-797-3477
Mailing address:
  • Phone: 508-853-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number214087
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: