Provider Demographics
NPI:1710472527
Name:STUBBS, SUSAN SAINA (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SAINA
Last Name:STUBBS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:SAINA
Other - Last Name:OTONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5017 TARTAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9639
Mailing Address - Country:US
Mailing Address - Phone:443-902-6314
Mailing Address - Fax:
Practice Address - Street 1:954 FORREST ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4236
Practice Address - Country:US
Practice Address - Phone:410-230-1542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine