MEDICARE: MARY SUSAN DEARMOND CRNFA

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	163WR0006X	Registered Nurse First Assistant	1039846	KY

General Provider Information

NPI Number	:	1548471741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SUSAN DEARMOND CRNFA

Provider Business Mailing Address
First Line	:	1206 MEADOWRIDGE TRL
Second Line	:
City	:	GOSHEN
State	:	KY
Zip	:	40026-9517
Country	:	US
Telephone Number	:	502-228-3175
Fax Number	:	502-228-3175

Provider Business Practice Location Address
First Line	:	4001 KRESGE WAY STE 200
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4640
Country	:	US
Telephone Number	:	502-895-1995
Fax Number	:	502-895-6479

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

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	12/16/2020

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