Provider Demographics
NPI:1043470966
Name:SUSSMAN, MARIE MAUDE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:MAUDE
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:282 JOCASSEE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SC
Mailing Address - Zip Code:29676
Mailing Address - Country:US
Mailing Address - Phone:914-391-8853
Mailing Address - Fax:
Practice Address - Street 1:1205 N HWY 11
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:SC
Practice Address - Zip Code:29696
Practice Address - Country:US
Practice Address - Phone:864-638-5402
Practice Address - Fax:864-638-6126
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420414-1363L00000X
SC18034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner