MEDICARE: SUSAN MARIE ELDER 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	163W00000X	Registered Nurse	1050463	KY

General Provider Information

NPI Number	:	1255860649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE ELDER R.N.

Provider Business Mailing Address
First Line	:	2816 ESTHER BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1102
Country	:	US
Telephone Number	:	502-777-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 ESTHER BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220
Country	:	US
Telephone Number	:	502-777-9702
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	07/21/2022

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