Provider Demographics
NPI:1285690966
Name:MARCEAU, SUSAN ANN (RN, MST, FNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:MARCEAU
Suffix:
Gender:F
Credentials:RN, MST, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-770-2043
Mailing Address - Fax:
Practice Address - Street 1:1 CVS DR
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-6146
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN33712363LF0000X
RINPP33712363LF0000X
MA194271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2036OtherBLUE CROSS BLUE SHIELD
MAM15639OtherBLUE CROSS BLUE SHIELD
MANP2036OtherBLUE CROSS BLUE SHIELD
MAM15639Medicare PIN
S91351Medicare UPIN