Provider Demographics
NPI:1790817146
Name:MACARTHUR, SUSAN G (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:MACARTHUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04617-0006
Mailing Address - Country:US
Mailing Address - Phone:207-326-9612
Mailing Address - Fax:
Practice Address - Street 1:42 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04402-0425
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN28496163W00000X
MECNP81127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431799399Medicaid
MENP070301Medicare PIN
MES33237Medicare UPIN