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Contact Information

SUSAN A DISTASIO, APRN
ONE MEDICAL CENTER DRIVE
DARTMOUTH HITCHCOCK - PAIN MEDICINE/ANESTHESIOLOGY
LEBANON, NH03756-0001
 Phone: 603-650-6039
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Oncology

364SX0200X 89 Certified Clinical Nurse Specialist
Indicates primary specialty

NPI Profile & details for SUSAN A DISTASIO · (Female)

NPI Number 1316975469
Status Active
Credentials APRN (Advanced Practice Registered Nurse)
Entity Individual
Enumeration date 06/29/2006
Last updated 05/09/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • CT License # 001896
  • NH License # 064077-23
  • CT Medicaid 4196368
Hospital affiliation(s)
  • ALICE PECK DAY MEMORIAL HOSPITAL - (Critical Access)
    10 ALICE PECK DAY DRIVE
    LEBANON, NH 03766
  • CHESHIRE MEDICAL CENTER - (Acute Care)
    580 COURT STREET
    KEENE, NH 03431
  • MARY HITCHCOCK MEMORIAL HOSPITAL - (Acute Care)
    1 MEDICAL CENTER DRIVE
    LEBANON, NH 03756
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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