Provider Demographics
NPI:1063743961
Name:CRUZ, SUSAN LEWIS (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEWIS
Last Name:CRUZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARLE ST APT 21
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5172
Mailing Address - Country:US
Mailing Address - Phone:207-660-6601
Mailing Address - Fax:
Practice Address - Street 1:30 CHASE AVE
Practice Address - Street 2:WORKPLACE HEALTH
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4624
Practice Address - Country:US
Practice Address - Phone:207-872-4260
Practice Address - Fax:207-872-4034
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP101004363LA2200X
DCRN1002135363LA2200X
MDAC000471363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health