Healthcare Provider Details

I. General information

NPI: 1871526319
Provider Name (Legal Business Name): SUSAN TRUEBLOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PRESTON ST
RANSON WV
25438-1631
US

IV. Provider business mailing address

4015 HARNEY RD
TANEYTOWN MD
21787-1735
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-1600
  • Fax: 304-728-1644
Mailing address:
  • Phone: 410-751-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69508
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: