Provider Demographics
NPI:1073403978
Name:HENRY, SUSAN LYNN (CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:HENRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11419 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:MD
Mailing Address - Zip Code:21660-1826
Mailing Address - Country:US
Mailing Address - Phone:443-786-2681
Mailing Address - Fax:
Practice Address - Street 1:415 MORGNEC RD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1046
Practice Address - Country:US
Practice Address - Phone:410-778-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148757363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner