Individual
CALLISTA M SUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6985 NEXUS CT STE 107, FAYETTEVILLE, NC 28304-3186
(910) 493-3999
(910) 728-4644
Mailing address
6985 NEXUS CT STE 107, FAYETTEVILLE, NC 28304-3186
(910) 493-3999
(910) 728-4644
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
RBT-21-167101
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09162021
—
FL
Enumeration date
09/16/2021
Last updated
09/16/2021
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