Healthcare Provider Details

I. General information

NPI: 1164566832
Provider Name (Legal Business Name): SUSAN KRAUSE EMERSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIE KRAUSE CPNP

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

1000 MEDICAL PARKWAY
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-6200
  • Fax:
Mailing address:
  • Phone: 443-481-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR190529
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: