=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952007494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE BOISVERT LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2023
-----------------------------------------------------
Last Update Date | 02/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 KENWOOD ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01301-1973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-223-5072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 KEENE RD
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03470-2305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-762-0611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 018798-22
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | LN-COND101526
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------