Provider Demographics
NPI:1386647832
Name:KISSELL, SUSAN HARWOOD (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HARWOOD
Last Name:KISSELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLEVELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3700
Mailing Address - Country:US
Mailing Address - Phone:276-632-4181
Mailing Address - Fax:276-632-1559
Practice Address - Street 1:101 CLEVELAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3700
Practice Address - Country:US
Practice Address - Phone:276-632-4181
Practice Address - Fax:276-632-1559
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily