=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144341140
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN L DUBUC APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1261 FURNACE BROOK PKWY STE 31
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-4762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-479-4545
-----------------------------------------------------
Fax | 617-479-4555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 819 COUNTY ST APT 64C
-----------------------------------------------------
City | TAUNTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02780-3766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-828-9655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 234537
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------