MEDICARE: SUSAN L BLANCHETTE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	155956	MA
2	163WX0601X	Otorhinolaryngology & Head-Neck Registered Nurse	155956	MA

General Provider Information

NPI Number	:	1144296401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L BLANCHETTE RN

Provider Business Mailing Address
First Line	:	6 ALDEN RD
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-5402
Country	:	US
Telephone Number	:	617-698-8056
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LONGWOOD AVE
Second Line	:	FLOOR 3
City	:	BOSTON
State	:	MA
Zip	:	02115-5711
Country	:	US
Telephone Number	:	617-355-8855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	09/11/2025

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