Provider Demographics
NPI:1174589097
Name:TANEY, SUSAN G (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:TANEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9811
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:802-748-4540
Practice Address - Street 1:201 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:VT
Practice Address - Zip Code:05824-0355
Practice Address - Country:US
Practice Address - Phone:802-695-2512
Practice Address - Fax:802-695-1303
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0020784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP0518Medicaid
VTR27238Medicare UPIN
VT0NP0518Medicaid
VT471801Medicare Oscar/Certification