Provider Demographics
NPI:1376715292
Name:WEBER, SUSAN R (BSN, RN,BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:WEBER
Suffix:
Gender:F
Credentials:BSN, RN,BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:H
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:252 S VALLEY DR APT 33
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4892
Mailing Address - Country:US
Mailing Address - Phone:585-329-7258
Mailing Address - Fax:
Practice Address - Street 1:871 HWY 150 SOURTH
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930
Practice Address - Country:US
Practice Address - Phone:307-789-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY471975163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult