Provider Demographics
NPI:1194765396
Name:GERMAIN, SUZANNE (NP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GERMAIN
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 1:74 MUNSILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1032
Mailing Address - Country:US
Mailing Address - Phone:802-453-5028
Mailing Address - Fax:802-453-6105
Practice Address - Street 1:74 MUNSILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1032
Practice Address - Country:US
Practice Address - Phone:802-453-5028
Practice Address - Fax:802-453-6105
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0012785363LW0102X
VT1010012785363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP0433Medicaid
VTR96893Medicare UPIN
NP207204Medicare PIN