Individual
SUSAN GRIZZARD PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
225 E WOOD ST, SPARTANBURG, SC 29303-3050
(864) 560-4420
(864) 560-5296
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4281
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7004655
—
NC
01
—
AA57905019
MEDICARE PIN
SC
05
—
NP1650
—
SC
01
—
P01322006
RAILROAD MEDICARE
SC
Enumeration date
07/08/2010
Last updated
12/02/2020
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