Healthcare Provider Details

I. General information

NPI: 1710402987
Provider Name (Legal Business Name): SUSAN KAREN HOBIN APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 11/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 PONTIAC AVE
CRANSTON RI
02920-4456
US

IV. Provider business mailing address

1220 PONTIAC AVE
CRANSTON RI
02920-4456
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-4660
  • Fax: 401-490-2021
Mailing address:
  • Phone: 401-943-4660
  • Fax: 401-490-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN01638
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberAPRN01638
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: