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MS. SUSAN OUELLETTE APRN

Psychiatric/Mental Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1720164320

Individual Registrant:
MS. SUSAN  OUELLETTE APRN
Gender: F
Not Sole Proprietor

Location and contact information for practice:
2124 RAMONA LN  WOODSTOCK, MD 21163-1248 US
Tel: 410-236-9951  Fax: --

Contact information for business:
2124 RAMONA LN  WOODSTOCK, MD 21163-1248 US
Tel: 410-236-9951  Fax: --

Registration Information:
NPI: 1720164320
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Psychiatric/Mental Health
CT003720
Y363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
MA0386509
N363LP0808XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
MDR117618

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
BLUE CROSS/BLUE SHIELDM644-0001MD01
MEDICARE NUMBER URBAN BEHAVIORAL ASSOCIATES015LM670MD01
772103000MD05
MAGELLAN537442000MD01
CAREFIRST61087301-PR31MD01




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