Provider Demographics
NPI:1598825689
Name:WERTMAN, SUZANNE (CNM)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:WERTMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 METTS AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2248
Mailing Address - Country:US
Mailing Address - Phone:910-632-5230
Mailing Address - Fax:
Practice Address - Street 1:1802 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6444
Practice Address - Country:US
Practice Address - Phone:910-343-1031
Practice Address - Fax:910-251-8896
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC373176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592955BMedicare PIN
NC2592955Medicare PIN
NC2592955AMedicare PIN
NC2592955DMedicare PIN
NC2592955CMedicare PIN
VIQ16049Medicare UPIN