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Individual
MRS. SUSAN CHRISTOS MCKENNEY
Active
Individual
MRS. SUSAN CHRISTOS MCKENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0050-00028
NC
363LF0000X
Family Nurse Practitioner
Primary
0050-00028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2592348B
MEDICARE PTAN
NC
01
—
560794933
TAX ID #
NC
01
—
S66124
MEDICARE/UNITED GOVT SERV
NC
Enumeration date
11/09/2005
Last updated
03/17/2018
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