Provider Demographics
NPI:1366776007
Name:ABBOTT, SUSAN ALLEN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ALLEN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ALLEN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13 RAILROAD SQ
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6139
Mailing Address - Country:US
Mailing Address - Phone:207-872-6869
Mailing Address - Fax:207-872-7910
Practice Address - Street 1:13 RAILROAD SQ
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6139
Practice Address - Country:US
Practice Address - Phone:207-872-6869
Practice Address - Fax:207-872-7910
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP091031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily