Provider Demographics
NPI:1396034310
Name:MCINNIS, SUSAN NICOLE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NICOLE
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-8550
Mailing Address - Fax:910-343-1924
Practice Address - Street 1:1090 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7353
Practice Address - Country:US
Practice Address - Phone:910-662-8550
Practice Address - Fax:910-343-1924
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily