Provider Demographics
NPI:1962513614
Name:FICHERA, SUSAN J (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:FICHERA
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 1:41 BUTTRICK RD
Mailing Address - Street 2:STE 4
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3367
Mailing Address - Country:US
Mailing Address - Phone:603-434-9666
Mailing Address - Fax:603-425-2973
Practice Address - Street 1:41 BUTTRICK RD
Practice Address - Street 2:STE 4
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3367
Practice Address - Country:US
Practice Address - Phone:603-434-9666
Practice Address - Fax:603-425-2973
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH019766-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344488Medicaid
NHP01156535OtherRAILROAD MEDICARE
NH3081847Medicaid
NHNP542801Medicare PIN