Healthcare Provider Details

I. General information

NPI: 1114117520
Provider Name (Legal Business Name): SUSAN WEATHERBY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN GILES

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 11/17/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 HOOKSETT RD
MANCHESTER NH
03104-2617
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 603-384-3900
  • Fax:
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number229966
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number045611-12
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: