Provider Demographics
NPI:1356734560
Name:NJENGA, SUSAN (CRNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:NJENGA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WESTBURY RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5542
Mailing Address - Country:US
Mailing Address - Phone:610-331-0204
Mailing Address - Fax:
Practice Address - Street 1:901 DULANEY VALLEY RD STE 220
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-0621
Practice Address - Country:US
Practice Address - Phone:410-583-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL6 0A00725367500000X
TXAP128889367500000X
MDAC 001552367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1356734560OtherNPI