Provider Demographics
NPI:1598123036
Name:PENNEY, SUSAN M (APRN, CNM, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PENNEY
Suffix:
Gender:
Credentials:APRN, CNM, PMHNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 OLD ROCHESTER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2028
Mailing Address - Country:US
Mailing Address - Phone:603-605-8268
Mailing Address - Fax:603-802-5099
Practice Address - Street 1:15 OLD ROLLINSFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2869
Practice Address - Country:US
Practice Address - Phone:603-742-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001441363L00000X, 367A00000X
NH065254-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102553000Medicaid
NH3103917Medicaid
NHT400299133Medicare PIN