MEDICARE: MS. SUSAN CONNOR R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist	168244	NC

General Provider Information

NPI Number	:	1144614629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN CONNOR R.N.

Provider Business Mailing Address
First Line	:	4432 MOUNTAIN COVE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-7764
Country	:	US
Telephone Number	:	919-924-6281
Fax Number	:

Provider Business Practice Location Address
First Line	:	4432 MOUNTAIN COVE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-7764
Country	:	US
Telephone Number	:	919-924-6281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	03/24/2015

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