Healthcare Provider Details

I. General information

NPI: 1649287293
Provider Name (Legal Business Name): SUSANNE W GIBBONS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANNE W SCHARNHORST CRNP

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 100
COLUMBIA MD
21045-3263
US

IV. Provider business mailing address

8186 LARK BROWN ROAD STE 201
ELKRIDGE MD
21075
US

V. Phone/Fax

Practice location:
  • Phone: 410-689-7400
  • Fax:
Mailing address:
  • Phone: 410-730-3399
  • Fax: 410-740-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR093831
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: