Healthcare Provider Details

I. General information

NPI: 1932414364
Provider Name (Legal Business Name): SUSAN R CARR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN RAE HOLBERT

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PENN AVE
HARRISVILLE WV
26362-1371
US

IV. Provider business mailing address

PO BOX 373
HARRISVILLE WV
26362-0373
US

V. Phone/Fax

Practice location:
  • Phone: 304-643-4005
  • Fax: 304-643-4007
Mailing address:
  • Phone: 304-643-4005
  • Fax: 304-643-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55537
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: