Provider Demographics
NPI:1255578282
Name:KLEIN, SUSAN (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BLUE DAMSEL CT
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8905
Mailing Address - Country:US
Mailing Address - Phone:603-858-0824
Mailing Address - Fax:
Practice Address - Street 1:12 BLUE DAMSEL CT
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8905
Practice Address - Country:US
Practice Address - Phone:603-858-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033069-23363LP0808X
NC61190163W00000X
NC5004994363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2595080Medicare UPIN