Healthcare Provider Details

I. General information

NPI: 1346349180
Provider Name (Legal Business Name): SUSAN LYNN CHASE NP, RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN CHASE-SHELLEY

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PLEASANT ST
BRUNSWICK ME
04011-2201
US

IV. Provider business mailing address

14 PLEASANT ST
BRUNSWICK ME
04011-2201
US

V. Phone/Fax

Practice location:
  • Phone: 207-419-9221
  • Fax: 207-729-0190
Mailing address:
  • Phone: 207-419-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN25666
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP81032
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS104003
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS104003
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: