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General NPI Number Information
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NPI Number | 1356239099
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Entity Type | Individual
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Provider Name | HALEY SUSAN GAUTHIER NP
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 15 HEALTH LN STE 2-D
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City | WARWICK
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State | RI
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Zip | 02886-2710
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Country | US
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Telephone | 401-736-4646
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Fax | 401-736-4546
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Provider Business Mailing Address
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Address Line | 455 TOLL GATE RD PRC AND CREDENTIALING
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City | WARWICK
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State | RI
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Zip | 02886
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Country | US
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Telephone | 401-273-0641
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Fax | 401-273-2919
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN04624
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License Number State | RI
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