Healthcare Provider Details

I. General information

NPI: 1154795607
Provider Name (Legal Business Name): SUSAN ANDERSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST CAB 3100
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

125 PATERSON ST CAB 3100
NEW BRUNSWICK NJ
08901-1962
US

V. Phone/Fax

Practice location:
  • Phone: 718-666-1342
  • Fax:
Mailing address:
  • Phone: 718-666-1342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00622200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR15594400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number26NJ00622200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: