MRS. SUSAN CAROLINE HERRON CRNP, NPI 1295861235 — WALDORF (MD)

NPI 1295861235

13+ Years Experience Individual

MRS. SUSAN CAROLINE HERRON CRNP

02/26/2007
PROVIDER ENUMERATION DATE
06/22/2018
LAST UPDATE DATE
1295861235
NPI NUMBER

About MRS. SUSAN CAROLINE HERRON

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

MRS. SUSAN CAROLINE HERRON is a provider established in WALDORF, MD. The NPI number of MRS. SUSAN CAROLINE HERRON is 1295861235 and was assigned on 02/26/2007. The practitioners primary taxonomy code is: 363LA2200X with license number: R070218 MD .

Mailing address

  • City: WALDORF
  • State: MD
  • Postal code: 20602
  • Phone: 3019325890
  • Fax: 3016456361
  • Address: 3510 OLD WASHINGTON ROAD
  • Address 2: SUITE 100

Primary Practice Address

  • Region : WALDORF, MD
  • NPI : 1295861235
  • Phone : 3019325890
  • Fax : 3016456361
  • Postalcode : 20602
  • Address : 3510 OLD WASHINGTON ROAD SUITE 100

Provider taxonomy - Nurse Practitioner

  • Taxonomy code: 363LA2200X
  • License number: R070218
  • License state: MD

The taxonomy is not the primary taxonomy.

Healthcare provider taxonomy #2 - Nurse Practitioner

  • Taxonomy code: 363LA2100X
  • License number: R070218
  • License state: MD

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Contacts:

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  • MRS. SUSAN CAROLINE HERRON CRNP
  • Address : 3510 OLD WASHINGTON ROAD SUITE 100
  • Region : WALDORF, MD
  • NPI : 1295861235
  • Phone : 3019325890
  • Fax : 3016456361
  • Postalcode : 20602

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address3510 OLD WASHINGTON ROAD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 100
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameWALDORF
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code20602
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3019325890
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3016456361
The fax number associated with the location address of the provider being identified.
NPI1295861235
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1363LA2200X
Provider Enumeration Date02/26/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated06/22/2018
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)MRS. SUSAN CAROLINE HERRON
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address3510 OLD WASHINGTON ROAD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 100
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameWALDORF
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code20602
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3019325890
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3016456361
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1363LA2200X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Nurse Practitioner
Provider License Number 1R070218
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MD
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2363LA2100X
Healthcare Provider Taxonomy 2Nurse Practitioner
Provider License Number 2R070218
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2MD
Healthcare Provider Primary Taxonomy Switch 2Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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