Individual
MS. SUSAN LEA THIEVON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., APRN
Contact information
Practice address
1422 ROUTE 66, RANDOLPH, VT 05060-7718
(802) 728-7100
Mailing address
1422 ROUTE 66, RANDOLPH, VT 05060-7718
(802) 728-7100
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
049495-23
NH
363LF0000X
Family Nurse Practitioner
Primary
101.0134836
VT
363LP2300X
Primary Care Nurse Practitioner
0494952303
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30341753
—
NH
05
—
3079327
—
NH
Enumeration date
09/02/2006
Last updated
01/07/2025
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