Individual
SUSAN W ETTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN,NPC
Contact information
Practice address
2360 W JOPPA RD, LUTHERVILLE TIMONIUM, MD 21093-4624
(410) 847-3535
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-5412
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
279604
MA
363L00000X
Nurse Practitioner
Primary
R078653
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0718126
—
MA
Enumeration date
09/13/2006
Last updated
02/05/2024
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