Provider Demographics
NPI:1689098089
Name:DOYLE, SUSAN LYNN (RN,BSN,CDNC,ADT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:DOYLE
Suffix:
Gender:F
Credentials:RN,BSN,CDNC,ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5614
Mailing Address - Country:US
Mailing Address - Phone:410-244-7350
Mailing Address - Fax:410-244-7351
Practice Address - Street 1:2117 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5614
Practice Address - Country:US
Practice Address - Phone:410-244-7350
Practice Address - Fax:410-244-7351
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089900163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)