Healthcare Provider Details

I. General information

NPI: 1972566271
Provider Name (Legal Business Name): SUZAN J MENIHAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WELLS ST SUITE 104
WESTERLY RI
02891-2927
US

IV. Provider business mailing address

45 WELLS ST SUITE 104
WESTERLY RI
02891-2927
US

V. Phone/Fax

Practice location:
  • Phone: 401-348-0008
  • Fax: 401-348-3053
Mailing address:
  • Phone: 401-348-0008
  • Fax: 401-348-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMM0296702
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: