Healthcare Provider Details

I. General information

NPI: 1063743961
Provider Name (Legal Business Name): SUSAN LEWIS CRUZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CHASE AVE WORKPLACE HEALTH
WATERVILLE ME
04901-4624
US

IV. Provider business mailing address

2 CARLE ST APT 21
WATERVILLE ME
04901-5172
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-4260
  • Fax: 207-872-4034
Mailing address:
  • Phone: 207-660-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP101004
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1002135
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAC000471
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: