Provider Demographics
NPI:1831465624
Name:GRUMBACH, SUSAN (MSN,APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GRUMBACH
Suffix:
Gender:F
Credentials:MSN,APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E DEKALB ST # C
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4432
Mailing Address - Country:US
Mailing Address - Phone:803-713-0806
Mailing Address - Fax:803-713-0526
Practice Address - Street 1:110 E DEKALB ST # C
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4432
Practice Address - Country:US
Practice Address - Phone:803-713-0806
Practice Address - Fax:803-713-0526
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF2185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily