Provider Demographics
NPI:1891931887
Name:VAN SOESTBERGEN, SUSAN BELK (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BELK
Last Name:VAN SOESTBERGEN
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 32861
Mailing Address - Street 2:ANESTHESIA SERVICES - 5TH FLOOR SURGICAL TOWER
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-355-8983
Mailing Address - Fax:704-355-8994
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:ANESTHESIA SERVICES -5TH FLOOR SURGICAL TOWER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-8983
Practice Address - Fax:704-355-8994
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC132662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC NAN 921Medicaid
NC8053699Medicaid
SCSC NAN 921Medicaid