Provider Demographics
NPI:1134150345
Name:BAZINET, SUSAN ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BAZINET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:220 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-715-3500
Practice Address - Fax:910-715-3501
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-00683363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003782Medicaid
NC184342OtherMEDCOST PROVIDER#
NCFH4000530OtherFIRSTCAROLINACARE PROV.#
NCP00278675OtherPALMETTO GBA PROVIDER#
SCNP0952OtherSC MEDICAID PROVIDER#
SCNP0952OtherSC MEDICAID PROVIDER#
P04325Medicare UPIN