Provider Demographics
NPI:1396993952
Name:HOOPER, SUSAN ALLEN (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALLEN
Last Name:HOOPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LOVERS LANE
Mailing Address - Street 2:
Mailing Address - City:MORETOWN
Mailing Address - State:VT
Mailing Address - Zip Code:05660
Mailing Address - Country:US
Mailing Address - Phone:802-999-5274
Mailing Address - Fax:802-888-8131
Practice Address - Street 1:528 WASHINGTON HIGHWAY
Practice Address - Street 2:ACU
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-8372
Practice Address - Fax:802-888-8131
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0023473363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner