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NPI Code Detail

MEDICARE: SUSAN M MCMULLEN CRNP

MEDICARE: SUSAN M MCMULLEN CRNP
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
1363LA2200XAdult Health Nurse PractitionerR137999MD
2363LA2200XAdult Health Nurse Practitioner55378WV

General Provider Information

NPI Number : 1194858266
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M MCMULLEN CRNP
Provider Business Mailing Address
First Line : 1 LAKESIDE LOOP
Second Line :
City : RIDGELEY
State : WV
Zip : 26753-9730
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10701 NEW GEORGES CREEK RD SW
Second Line :
City : FROSTBURG
State : MD
Zip : 21532-1457
Country : US
Telephone Number : 301-689-3229
Fax Number : 301-689-1129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/08/2007

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Directions to “ SUSAN M MCMULLEN CRNP” Practice Location

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