Healthcare Provider Details

I. General information

NPI: 1023304235
Provider Name (Legal Business Name): SUZANNE NICOLE SUPRENANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

IV. Provider business mailing address

11 VANDERBILT PARK DR
ASHEVILLE NC
28803-1700
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-1111
  • Fax:
Mailing address:
  • Phone: 828-213-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number173473
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2017-00844
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: