Provider Demographics
NPI:1144614629
Name:CONNOR, SUSAN (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 MOUNTAIN COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7764
Mailing Address - Country:US
Mailing Address - Phone:919-924-6281
Mailing Address - Fax:
Practice Address - Street 1:4432 MOUNTAIN COVE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7764
Practice Address - Country:US
Practice Address - Phone:919-924-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC168244225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist