Provider Demographics
NPI:1467409144
Name:WADDELL, ROBIN SUSAN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:SUSAN
Last Name:WADDELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:478 ELK MILLS RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-3806
Mailing Address - Country:US
Mailing Address - Phone:410-996-5130
Mailing Address - Fax:410-996-5179
Practice Address - Street 1:401 BOW ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5501
Practice Address - Country:US
Practice Address - Phone:410-996-5130
Practice Address - Fax:410-996-5179
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR064834363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health