Provider Demographics
NPI:1043413800
Name:AKRIDGE, SUSAN (RN, CDE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:AKRIDGE
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-0996
Mailing Address - Country:US
Mailing Address - Phone:301-714-4041
Mailing Address - Fax:301-714-4531
Practice Address - Street 1:11110 MEDICAL CAMPUS RD
Practice Address - Street 2:SUTIE 108
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6700
Practice Address - Country:US
Practice Address - Phone:301-714-4041
Practice Address - Fax:301-714-4531
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR082255163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator