Provider Demographics
NPI:1275800146
Name:WEBER, SUSAN CAROL (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CAROL
Last Name:WEBER
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 1:770 EMBOUGHT RD
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-5312
Mailing Address - Country:US
Mailing Address - Phone:518-943-0574
Mailing Address - Fax:518-943-5396
Practice Address - Street 1:770 EMBOUGHT RD
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-5312
Practice Address - Country:US
Practice Address - Phone:518-943-0574
Practice Address - Fax:518-943-5396
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310930-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool