Healthcare Provider Details

I. General information

NPI: 1760894901
Provider Name (Legal Business Name): SUSAN ORSBON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 HIGHWAY 70 W
DICKSON TN
37055-4234
US

IV. Provider business mailing address

10256 MCGEE RD
LYLES TN
37098-1738
US

V. Phone/Fax

Practice location:
  • Phone: 615-326-8121
  • Fax:
Mailing address:
  • Phone: 615-512-4099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number145253
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19587
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: