MEDICARE: SUSAN R LORD NP

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	363LF0000X	Family Nurse Practitioner	R-023932	ME
2	363LW0102X	Women's Health Nurse Practitioner	R-023932	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891779492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN R LORD NP

Provider Business Mailing Address
First Line	:	PO BOX 866
Second Line	:
City	:	ROCKLAND
State	:	ME
Zip	:	04841-0866
Country	:	US
Telephone Number	:	207-594-3114
Fax Number	:	207-594-3108

Provider Business Practice Location Address
First Line	:	22 WHITE ST
Second Line	:
City	:	ROCKLAND
State	:	ME
Zip	:	04841-2978
Country	:	US
Telephone Number	:	207-594-3114
Fax Number	:	207-594-3108

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	11/16/2010

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