Smith, Susan Spivock

Smith, Susan Spivock is an sole proprietor health care provider with primary practice located at 100 Brewster Blvd Naval Hospital, Camp Lejeune NC 28548-2538. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Smith, Susan Spivock can be contacted via phone (910) 450-4159.

Contact Information

Primary practice address
100 Brewster Blvd Naval Hospital Camp Lejeune NC 28548-2538
Phone: (910) 450-4159
Fax: (910) 450-4194
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X R108147 Maryland

Profile Details

NPI number 1336144252
LBN Legal business name Smith, Susan Spivock
Credentials CRNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 16th, 2005
Last updated Oct 25th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336144252 NPPES
Maryland MEDICAID 553211600

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