1295861235 NPI number — MRS. SUSAN CAROLINE HERRON CRNP

Table of content: MRS. SUSAN CAROLINE HERRON CRNP (NPI 1295861235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295861235 NPI number — MRS. SUSAN CAROLINE HERRON CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRON
Provider First Name:
SUSAN
Provider Middle Name:
CAROLINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON-WILSON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
CAROLINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295861235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3510 OLD WASHINGTON ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-932-5890
Provider Business Mailing Address Fax Number:
301-645-6361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3510 OLD WASHINGTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-932-5890
Provider Business Practice Location Address Fax Number:
301-645-6361
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R070218 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: R070218 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com