Healthcare Provider Details

I. General information

NPI: 1760458541
Provider Name (Legal Business Name): SUSAN R. BUCKLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN DEMARCO ARNP

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST SUITE G2
CONCORD NH
03301-7539
US

IV. Provider business mailing address

246 PLEASANT ST SUITE G2
CONCORD NH
03301-7539
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3388
  • Fax: 603-225-3557
Mailing address:
  • Phone: 603-224-3388
  • Fax: 603-225-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number039259-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: