Provider Demographics
NPI:1518147248
Name:NORDSTROM, SUSAN M (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:LAMEIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:67 DUTCH HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962
Mailing Address - Country:US
Mailing Address - Phone:845-629-9900
Mailing Address - Fax:845-613-7809
Practice Address - Street 1:67 DUTCH HOLLOW DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962
Practice Address - Country:US
Practice Address - Phone:845-629-9900
Practice Address - Fax:845-613-7809
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY470128163W00000X, 163WC0400X, 163WC1500X, 163WC3500X, 163WG0000X, 163WH0200X, 163WH1000X, 163WI0500X, 163WN1003X, 163WP0808X, 163WP2201X
NY470128-1163WG0000X, 163WI0500X, 163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01785148Medicaid