Healthcare Provider Details

I. General information

NPI: 1720164320
Provider Name (Legal Business Name): SUSAN OUELLETTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 RAMONA LN
WOODSTOCK MD
21163-1248
US

IV. Provider business mailing address

2124 RAMONA LN
WOODSTOCK MD
21163-1248
US

V. Phone/Fax

Practice location:
  • Phone: 410-236-9951
  • Fax:
Mailing address:
  • Phone: 410-236-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number00000
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number003720
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR117618
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36255
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0386509
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: