Basic Information
| Provider Information | |||||||||
| NPI: | 1851317523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN HORNE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 SEAVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027771118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086722923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 THURBERS AVE | ||||||||
| Address2: | C/O FAMILY SERVICE OF RHODE ISLAND | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029054754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013311350 | ||||||||
| FaxNumber: | 4012773366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| 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 | 163W00000X | RN41794 | RI | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | SV58404 | 05 | RI | MEDICAID |