Susan Ann Carmack, CPNP

Individual provider Active NPI Pediatric Nurse Practitioner · Washington, DC

NPI 1881687697 · NPPES record last updated Jun 29, 2009

Key facts

NPI
1881687697
Entity type
Individual (NPI type 1)
Primary specialty
Pediatric Nurse Practitioner 363LP0200X
License
28067924A (IN)
Practice address
Peace Corps Office of Medical Services
1111 20TH Street NW
Washington, DC 20526-0001
Phone
(202) 692-1555
Fax
(202) 692-1501
NPI assigned
Aug 26, 2005
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Certified Pediatric Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28067924AINMDPediatric Nurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 28067924A IN Yes

Addresses

Primary practice location

Peace Corps Office of Medical Services
1111 20TH Street NW
Washington, DC 20526-0001

Mailing address

12806 Brightwell Dr
Clarksburg, MD 20871-4309
Phone (301) 540-2541

Other providers in Washington, DC

All providers in Washington, DC · Pediatric Nurse Practitioner in District of Columbia

Sources for this page

Verify at the official NPI Registry.