Provider Demographics
NPI:1053641837
Name:CARRIER, SUSAN MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:CARRIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SHERMAN ST
Mailing Address - Street 2:PO BOX 414
Mailing Address - City:BELFAST
Mailing Address - State:NY
Mailing Address - Zip Code:14711-8756
Mailing Address - Country:US
Mailing Address - Phone:585-365-2159
Mailing Address - Fax:
Practice Address - Street 1:61 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:NY
Practice Address - Zip Code:14711-8756
Practice Address - Country:US
Practice Address - Phone:585-365-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294050-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse