Provider Demographics
NPI:1932355476
Name:AUSSICKER, SUSAN BARD
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BARD
Last Name:AUSSICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MIDLINE RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9525
Mailing Address - Country:US
Mailing Address - Phone:518-309-3766
Mailing Address - Fax:
Practice Address - Street 1:124 MIDLINE RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-9525
Practice Address - Country:US
Practice Address - Phone:518-309-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466494-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse