SUSAN ELLSBERRY C.R.N.A., NPI 1710984356 — BALTIMORE (MD)

NPI 1710984356

14+ Years Experience Individual

SUSAN ELLSBERRY C.R.N.A.

06/28/2005
PROVIDER ENUMERATION DATE
06.06.2012
LAST UPDATE DATE
1710984356
NPI NUMBER

About SUSAN ELLSBERRY

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

SUSAN ELLSBERRY is a provider established in BALTIMORE, MD. The NPI number of SUSAN ELLSBERRY is 1710984356 and was assigned on 06/28/2005. The practitioners primary taxonomy code is: 174400000X with license number: R093801 MD .

Mailing address

  • City: BALTIMORE
  • State: MD
  • Postal code: 212241129
  • Address: 2610 E BALTIMORE ST

Primary Practice Address

  • Region : BALTIMORE, MD
  • NPI : 1710984356
  • Phone : 4108217644
  • Postalcode : 212241129
  • Address : 2610 E BALTIMORE ST

Additional identifiers

  • Identifier: 454MG840
  • Code / Type : 1 - other
  • Identifier state : MD
  • Identifier issuer: TRAILBLAZER

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 984560700
  • Code / Type : 5 - MEDICAID
  • Identifier state : MD

Provider taxonomy - Specialist

  • Taxonomy code: 174400000X
  • License number: R093801
  • License state: MD

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

Taxonomy description: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Contacts:

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  • SUSAN ELLSBERRY C.R.N.A.
  • Address : 2610 E BALTIMORE ST
  • Region : BALTIMORE, MD
  • NPI : 1710984356
  • Phone : 4108217644
  • Postalcode : 212241129

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

Field Name Value
Provider First Line Business Practice Location Address2610 E BALTIMORE ST
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 Business Practice Location Address City NameBALTIMORE
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 Code212241129
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 Number4108217644
The telephone number associated with the location address of the provider being identified.
NPI1710984356
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1174400000X
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Provider Enumeration Date06/28/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated06.06.2012
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)SUSAN ELLSBERRY
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 Address2610 E BALTIMORE ST
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 Business Mailing Address City NameBALTIMORE
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 Code212241129
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".
Healthcare Provider Taxonomy Code #1174400000X
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 1Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Provider License Number 1R093801
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 1Y
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.
Other Provider Identifier 1454MG840
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1MD
Other Provider Identifier State #1
Other Provider Identifier Issuer 1TRAILBLAZER
Other Provider Identifier Issuer #1
Other Provider Identifier 2984560700
Other Provider Identifier #2
Other Provider Identifier Type 25
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2MD
Other Provider Identifier State #2
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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