Basic Information
| Provider Information | |||||||||
| NPI: | 1730261306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOONE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | PECK | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 GROVE ST | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020383156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085285392 | ||||||||
| FaxNumber: | 5085412420 | ||||||||
| Practice Location | |||||||||
| Address1: | 94 MENDON ST | ||||||||
| Address2: | |||||||||
| City: | HOPEDALE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017471311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084825401 | ||||||||
| FaxNumber: | 5084825402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| 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 | 363LA2200X | 124212 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | NP2417 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 55350 | 01 | MA | FALLON | OTHER |