Provider Demographics
NPI:1720083215
Name:WESTMORELAND, SUSANNE M (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:M
Last Name:WESTMORELAND
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 1:2954 HAMPTON COVE WAY SE
Mailing Address - Street 2:P.O. BOX 247
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9330
Mailing Address - Country:US
Mailing Address - Phone:256-426-8128
Mailing Address - Fax:
Practice Address - Street 1:401 LOWELL DR SE
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3748
Practice Address - Country:US
Practice Address - Phone:256-265-1775
Practice Address - Fax:256-265-1780
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1093786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS43667Medicare UPIN