Individual
SUSAN WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
88 TERRY RD, SMITHTOWN, NY 11787-3811
(631) 533-3009
Mailing address
88 TERRY RD, SMITHTOWN, NY 11787-3811
(631) 533-3009
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
660859
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402433
NY
Other
Enumeration date
12/19/2013
Last updated
08/27/2020
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