Healthcare Provider Details

I. General information

NPI: 1770567067
Provider Name (Legal Business Name): SUSAN M PERRY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SUSAN BROWDER CARTER

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR 88MDG
WPAFB OH
45433
US

IV. Provider business mailing address

PO BOX 640446
CINCINNATI OH
45264-0446
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-0837
  • Fax:
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number567115
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN323057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: