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MS. SUSAN OUELLETTE APRN
Psychiatric/Mental Health >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1720164320
Individual Registrant:MS. SUSAN OUELLETTE APRN
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
2124 RAMONA LN WOODSTOCK, MD 21163-1248 US
Tel: 410-236-9951 Fax: --
Tel: 410-236-9951 Fax: --
Contact information for business:
2124 RAMONA LN WOODSTOCK, MD 21163-1248 US
Tel: 410-236-9951 Fax: --
Tel: 410-236-9951 Fax: --
Registration Information:
NPI: 1720164320
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Psychiatric/Mental Health | CT | 003720 |
| Y | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | MA | 0386509 |
| N | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | MD | R117618 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BLUE CROSS/BLUE SHIELD | M644-0001 | MD | 01 |
| MEDICARE NUMBER URBAN BEHAVIORAL ASSOCIATES | 015LM670 | MD | 01 |
| 772103000 | MD | 05 | |
| MAGELLAN | 537442000 | MD | 01 |
| CAREFIRST | 61087301-PR31 | MD | 01 |
