Individual
SUSAN ELLSBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
2610 E BALTIMORE ST, BALTIMORE, MD 21224-1129
(410) 821-7644
Mailing address
2610 E BALTIMORE ST, BALTIMORE, MD 21224-1129
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R093801
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
454MG840
TRAILBLAZER
MD
05
—
984560700
—
MD
Enumeration date
06/28/2005
Last updated
06/06/2012
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