Provider Demographics
NPI:1811326457
Name:MCCORMICK, SUSANNE LINDSAY I (CRNA)
Entity type:Individual
Prefix:MISS
First Name:SUSANNE
Middle Name:LINDSAY
Last Name:MCCORMICK
Suffix:I
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 1:649 N WILKINSON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-1247
Mailing Address - Country:US
Mailing Address - Phone:843-877-3892
Mailing Address - Fax:
Practice Address - Street 1:649 N WILKINSON DR
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1247
Practice Address - Country:US
Practice Address - Phone:843-877-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18544367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered