Individual
MS. SUSAN A DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
ONE MEDICAL CENTER DRIVE, DARTMOUTH HITCHCOCK - PAIN MEDICINE/ANESTHESIOLOGY, LEBANON, NH 03756-0001
(603) 650-6039
Mailing address
ONE MEDICAL CENTER DRIVE, DARTMOUTH HITCHCOCK - PAIN MEDICINE/ANESTHESIOLOGY, LEBANON, NH 03756-0001
(603) 650-6039
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
064077-23
NH
364SX0200X
Oncology Clinical Nurse Specialist
001896
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4196368
—
CT
Enumeration date
06/29/2006
Last updated
05/09/2017
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