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NPI Code Detail

MEDICARE: MRS. SUSANNE T BAISCH FNP

MEDICARE: MRS. SUSANNE T BAISCH FNP
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
1363LF0000XFamily Nurse PractitionerAPN 2105SC

General Provider Information

NPI Number : 1912908344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSANNE T BAISCH FNP
Provider Business Mailing Address
First Line : 1109 LAUREL ST
Second Line :
City : PORT ROYAL
State : SC
Zip : 29935-1911
Country : US
Telephone Number : 843-271-2713
Fax Number :
Provider Business Practice Location Address
First Line : 1680B RIBAUT RD
Second Line :
City : PORT ROYAL
State : SC
Zip : 29935-2008
Country : US
Telephone Number : 843-521-9879
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 02/18/2014

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