Basic Information
Provider Information
NPI: 1003802018
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS-SUICH
FirstName: CAROL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 ALICE PECK DAY DR
Address2:  
City: LEBANON
State: NH
PostalCode: 037662694
CountryCode: US
TelephoneNumber: 6034483121
FaxNumber: 6034487462
Practice Location
Address1: 5 ALICE PECK DAY DR
Address2:  
City: LEBANON
State: NH
PostalCode: 037662901
CountryCode: US
TelephoneNumber: 6034483122
FaxNumber: 6034487491
Other Information
ProviderEnumerationDate: 09/26/2005
LastUpdateDate: 04/08/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X030025-23-03NHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
0001904701VTBCBSVTOTHER
08P45601NHMVPOTHER
0NP023605VT MEDICAID
3000499205NH MEDICAID


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