Healthcare Provider Details

I. General information

NPI: 1780545921
Provider Name (Legal Business Name): SUSANNE URICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL LN
JELLICO TN
37762-4400
US

IV. Provider business mailing address

3504 HIGHWAY 153 UNIT 242
GREENVILLE SC
29611-7553
US

V. Phone/Fax

Practice location:
  • Phone: 423-455-0245
  • Fax:
Mailing address:
  • Phone: 864-905-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number62709
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: