Provider Demographics
NPI:1699745307
Name:PRUYN, SUSAN A (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:PRUYN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:25 RANDLETT PARK
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1716
Mailing Address - Country:US
Mailing Address - Phone:617-965-0480
Mailing Address - Fax:617-234-7981
Practice Address - Street 1:YOUVILLE HOSPITAL
Practice Address - Street 2:1575 CAMBRIDGE STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-876-4344
Practice Address - Fax:617-234-7981
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-12-10
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Provider Licenses
StateLicense IDTaxonomies
MA175363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58258Medicare UPIN