| NPI | 1235447350 |
|---|---|
| Former Name | SUSAN MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 19043) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F305403-1) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2014-10-09 |