Basic Information
| Provider Information | |||||||||
| NPI: | 1689634800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURLEY | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1098 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027380020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7745535075 | ||||||||
| FaxNumber: | 7745535058 | ||||||||
| Practice Location | |||||||||
| Address1: | 41 MALL RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817445100 | ||||||||
| FaxNumber: | 7817442521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 138309 | MA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 138309 | MA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0707911 | 05 | MA | MEDICAID | NP5198 | 01 | MA | BLUE CROSS | OTHER | AA45161 | 01 | MA | HARVARD PILGRIM | OTHER |