Provider Demographics
NPI:1942091178
Name:SUSEN, GABRIEL WILLIAM (RN)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:WILLIAM
Last Name:SUSEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1718
Mailing Address - Country:US
Mailing Address - Phone:207-290-7365
Mailing Address - Fax:
Practice Address - Street 1:7 TRANSALPINE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4222
Practice Address - Country:US
Practice Address - Phone:207-794-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95271729163W00000X
MERN74008163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse