Provider Demographics
NPI:1972628600
Name:CLARKE, SUSAN WINSTEAD (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WINSTEAD
Last Name:CLARKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221A PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4303
Mailing Address - Country:US
Mailing Address - Phone:252-726-5767
Mailing Address - Fax:252-726-7573
Practice Address - Street 1:221A PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4303
Practice Address - Country:US
Practice Address - Phone:252-726-5767
Practice Address - Fax:252-726-7573
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily