Provider Demographics
NPI:1154324465
Name:KEISTER, SUSAN JOYCE (MS, CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JOYCE
Last Name:KEISTER
Suffix:
Gender:F
Credentials:MS, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3732
Mailing Address - Country:US
Mailing Address - Phone:301-724-5992
Mailing Address - Fax:301-724-0505
Practice Address - Street 1:500 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3732
Practice Address - Country:US
Practice Address - Phone:301-724-5992
Practice Address - Fax:301-724-0505
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR048397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD867DMedicare ID - Type UnspecifiedRENDERING NUMBER
MDS88758Medicare UPIN
MD790LMedicare ID - Type UnspecifiedGROUP