| NPI | 1992761027 |
|---|---|
| Former Name | SUSAN C DIVVER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA 110835) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA 110835) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2011-06-13 |