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Individual
MS. SUSAN CARLISLE
Active
Individual
MS. SUSAN CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0000081
NY
363A00000X
Physician Assistant
Primary
005198-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01611072
—
NY
Enumeration date
07/27/2006
Last updated
03/10/2021
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