Provider Demographics
NPI:1851758544
Name:PRICE, MARY SUSAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUSAN
Last Name:PRICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:SUSAN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:149 TWIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2538
Mailing Address - Country:US
Mailing Address - Phone:864-206-2138
Mailing Address - Fax:864-902-3628
Practice Address - Street 1:149 TWIN LAKE RD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2538
Practice Address - Country:US
Practice Address - Phone:864-206-2138
Practice Address - Fax:864-902-3628
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51258163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse