MEDICARE: MS. SUSAN HARWOOD KISSELL 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
1	363LF0000X	Family Nurse Practitioner	R069533	MD

General Provider Information

NPI Number	:	1386647832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN HARWOOD KISSELL CRNP

Provider Business Mailing Address
First Line	:	101 CLEVELAND AVE
Second Line	:	SUITE A
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-3700
Country	:	US
Telephone Number	:	276-632-4181
Fax Number	:	276-632-1559

Provider Business Practice Location Address
First Line	:	101 CLEVELAND AVE
Second Line	:	SUITE A
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-3700
Country	:	US
Telephone Number	:	276-632-4181
Fax Number	:	276-632-1559

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	08/05/2014

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