Provider Demographics
NPI:1912908344
Name:BAISCH, SUSANNE T (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:T
Last Name:BAISCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:FRANCES
Other - Middle Name:SUSANNE
Other - Last Name:TUTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1109 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1911
Mailing Address - Country:US
Mailing Address - Phone:843-271-2713
Mailing Address - Fax:
Practice Address - Street 1:1680B RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2008
Practice Address - Country:US
Practice Address - Phone:843-521-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily