Healthcare Provider Details

I. General information

NPI: 1588793772
Provider Name (Legal Business Name): SUSAN ENZER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY # 1
EAST PROVIDENCE RI
02914-5300
US

IV. Provider business mailing address

11 OLD CHIMNEY RD
BARRINGTON RI
02806-3224
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-5644
  • Fax:
Mailing address:
  • Phone: 401-247-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00075
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: