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General NPI Number Information
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NPI Number | 1538398698
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Entity Type | Individual
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Provider Name | SUSAN ELLEN BLAKELY RN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 1563 N MAIN ST
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City | FALL RIVER
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State | MA
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Zip | 02720-2983
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Country | US
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Telephone | 508-324-0328
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Fax | 508-679-8590
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Provider Business Mailing Address
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Address Line | 65 BUCKWHEAT AVE
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City | PORTSMOUTH
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State | RI
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Zip | 02871-1101
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Country | US
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Telephone | 401-924-4763
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 275476
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 19539
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License Number State | RI
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