Provider Demographics
NPI:1043367030
Name:CUSSON, SUSAN E (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:CUSSON
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 1:100 OLD BILLERICA RD
Mailing Address - Street 2:CARLETON-WILLARD VILLAGE
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1267
Mailing Address - Country:US
Mailing Address - Phone:781-275-8700
Mailing Address - Fax:781-276-1934
Practice Address - Street 1:100 OLD BILLERICA RD
Practice Address - Street 2:CARLETON-WILLARD VILLAGE
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1267
Practice Address - Country:US
Practice Address - Phone:781-275-8700
Practice Address - Fax:781-276-1934
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN174128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2935OtherBCBSMA
MA110076851AMedicaid
MA110076851AMedicaid
MA110076851AMedicaid