Most Relevant Information
Provider Data
| NPI Number: | 1003562406 |
| Provider Name: | SUSAN PENQUE |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 10088 |
Most Important Dates
| Enumeration Date: | 02/23/2022 |
| Last Updated: | 02/23/2022 |
Provider Practice Location
18 FRANS WAY
SHELTON
CT
064842182
Practice Location Phone/Fax
| Phone: | 5166406195 |
| Fax: |
Provider Mailing Location
18 FRANS WAY
SHELTON
CT
064842182
Provider Mailing Phone/Fax
| Phone: | 5166406195 |
| Fax: |