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General NPI Number Information
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NPI Number | 1184845935
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Entity Type | Individual
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Provider Name | SUSAN MILLER RANNESTAD CM, LM
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 209 BOYCE RD
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City | PINE BUSH
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State | NY
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Zip | 12566-6809
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Country | US
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Telephone | 845-282-2229
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Fax | 845-744-5219
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Provider Business Mailing Address
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Address Line | 209 BOYCE RD
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City | PINE BUSH
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State | NY
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Zip | 12566-6809
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Country | US
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Telephone | 845-744-5219
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Fax | 845-744-5219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | F001271
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License Number State | NY
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