Provider Demographics
NPI:1952007494
Name:BOISVERT, SUZANNE (LPN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 KEENE RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03470-2305
Mailing Address - Country:US
Mailing Address - Phone:603-762-0611
Mailing Address - Fax:
Practice Address - Street 1:21 KENWOOD ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1973
Practice Address - Country:US
Practice Address - Phone:413-223-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH018798-22164W00000X
MALN-COND101526164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse