Provider Demographics
NPI:1922165612
Name:THOMAS, SUSAN B (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:F
Other - Last Name:BRYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3336
Mailing Address - Fax:910-251-2066
Practice Address - Street 1:1202 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7307
Practice Address - Country:US
Practice Address - Phone:910-341-3336
Practice Address - Fax:910-251-2066
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69218363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC500005566OtherRAILROAD MEDICARE
NC2594763EMedicare PIN
NC500005566OtherRAILROAD MEDICARE
NC2594763BMedicare PIN
NC2594763AMedicare PIN
NC2594763CMedicare PIN
NC2594763DMedicare PIN