Provider Demographics
NPI:1184722605
Name:CARTMELL, SU P (CRNP)
Entity type:Individual
Prefix:MRS
First Name:SU
Middle Name:P
Last Name:CARTMELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HALES WOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7228
Mailing Address - Country:US
Mailing Address - Phone:610-733-8418
Mailing Address - Fax:
Practice Address - Street 1:299 LLOYD ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1821
Practice Address - Country:US
Practice Address - Phone:919-537-7487
Practice Address - Fax:919-537-0469
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003935H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1790780Medicaid
PAMC0995398OtherDEA NUMBER
PA1790780Medicaid
PA021758Medicare PIN