Healthcare Provider Details

I. General information

NPI: 1790817146
Provider Name (Legal Business Name): SUSAN G. MACARTHUR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR STREET
BANGOR ME
04402-0425
US

IV. Provider business mailing address

PO BOX 6
BROOKSVILLE ME
04617-0006
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax:
Mailing address:
  • Phone: 207-326-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN28496
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP81127
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: