Provider Demographics
NPI:1295358760
Name:WHITE-DRAGON, SUSAN REBECCA (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:REBECCA
Last Name:WHITE-DRAGON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:REBECCA
Other - Last Name:UNFRIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3807 JUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1813
Mailing Address - Country:US
Mailing Address - Phone:443-617-4181
Mailing Address - Fax:
Practice Address - Street 1:110 BAUGHMANS LN STE 140
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4649
Practice Address - Country:US
Practice Address - Phone:240-215-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily