Provider Demographics
NPI:1275697625
Name:COLLINS-JOERGER, SUSAN EVELYN (NEONATAL NURSE PRACT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:EVELYN
Last Name:COLLINS-JOERGER
Suffix:
Gender:F
Credentials:NEONATAL NURSE PRACT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:EVELYN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP - BC
Mailing Address - Street 1:4 TRAILS END
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1738
Mailing Address - Country:US
Mailing Address - Phone:864-884-4149
Mailing Address - Fax:
Practice Address - Street 1:125 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4812
Practice Address - Country:US
Practice Address - Phone:864-675-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALC#######363LN0005X
SCAPN.1440RX363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care