Healthcare Provider Details

I. General information

NPI: 1215247531
Provider Name (Legal Business Name): SUSAN KARLSON-BURT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 JOY'S LANE
KINGSTON NY
12401
US

IV. Provider business mailing address

1500 ROUTE 32
SAUGERTIES NY
12477
US

V. Phone/Fax

Practice location:
  • Phone: 845-336-0622
  • Fax: 845-331-0492
Mailing address:
  • Phone: 845-331-5064
  • Fax: 845-331-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number309093-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: