Provider Demographics
NPI:1285754614
Name:SUGHRUE, MARK R (MSN, APRN-BC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:SUGHRUE
Suffix:
Gender:M
Credentials:MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PEABODY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6424
Mailing Address - Country:US
Mailing Address - Phone:603-347-5520
Mailing Address - Fax:
Practice Address - Street 1:21 PEABODY DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-6424
Practice Address - Country:US
Practice Address - Phone:603-347-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN250422363L00000X
MECNP231045363L00000X
NH058300-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30346055Medicaid
P79847Medicare UPIN
NH30346055Medicaid