Provider Demographics
NPI:1154627529
Name:GISCOMBE, SUSAN RENEE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RENEE
Last Name:GISCOMBE
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:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-0900
Mailing Address - Country:US
Mailing Address - Phone:410-871-6111
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5726
Practice Address - Country:US
Practice Address - Phone:410-871-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR176433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily