Provider Demographics
NPI:1811122013
Name:SEVERSON, SUSAN (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 480 BOX 1471
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128-0015
Mailing Address - Country:US
Mailing Address - Phone:711-305-7588
Mailing Address - Fax:
Practice Address - Street 1:CMR 480 BOX 1471
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09128-0015
Practice Address - Country:US
Practice Address - Phone:711-305-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090718163W00000X
COUNKNOWN163W00000X
CAUNKNOWN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse