Basic Information
| Provider Information | |||||||||
| NPI: | 1972577096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROSSLEY | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683110 | ||||||||
| FaxNumber: | 5083683113 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | SUITE 150 S | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683110 | ||||||||
| FaxNumber: | 5083683113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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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 | 367A00000X | 193924 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 3163834 | 01 | CIGNA HEALTH PLAN | OTHER | 39861 | 01 | HEALTHY START | OTHER | 0381250 | 01 | MEDICAID WELFARE | OTHER | CN0160 | 01 | BLUE SHIELD INDEMNITY | OTHER | 381305 | 01 | MVP HEALTH CARE | OTHER | AA3470 | 01 | HARVARD PILGRIM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | CN0160 | 01 | BLUE CARE ELECT | OTHER | CN0160 | 01 | BLUE SHIELD HMO BLUE | OTHER | 0381250 | 05 | MA | MEDICAID | 39861 | 01 | CHILDRENS MED SECURITY | OTHER | 61212 | 01 | FALLON COMMUNITY HEALTH | OTHER | 7977623 | 01 | AETNA US HEALTHCARE | OTHER | RN0018 | 01 | MEDICARE B | OTHER | 04247226 | 01 | ONE HEALTH PLAN | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER |