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General NPI Number Information
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NPI Number | 1346271657
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Entity Type | Individual
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Provider Name | SUSAN B ANTHONY CRNP, MS
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 8800 WALTHER BLVD
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City | BALTIMORE
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State | MD
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Zip | 21234-9001
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Country | US
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Telephone | 410-882-3240
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Fax | 410-661-5093
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Provider Business Mailing Address
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Address Line | 5525 RESEARCH PARK DR 4TH FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21228-4873
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Country | US
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Telephone | 410-882-3240
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Fax | 410-661-5093
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R079544
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License Number State | MD
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