Provider Demographics
NPI:1053064105
Name:PETRUS, SUSAN (CD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PETRUS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2379 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1206
Mailing Address - Country:US
Mailing Address - Phone:205-222-0343
Mailing Address - Fax:
Practice Address - Street 1:2379 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1206
Practice Address - Country:US
Practice Address - Phone:205-222-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty