Basic Information
Provider Information
NPI: 1003002346
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORDENTE
FirstName: SUSAN
MiddleName: C.
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2007 ROCK SPRING RD
Address2:  
City: FOREST HILL
State: MD
PostalCode: 210502620
CountryCode: US
TelephoneNumber: 4108792474
FaxNumber:  
Practice Location
Address1: 2007 ROCK SPRING RD
Address2:  
City: FOREST HILL
State: MD
PostalCode: 210502620
CountryCode: US
TelephoneNumber: 4108792474
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/20/2007
LastUpdateDate: 09/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WR0006XR044128MDY Nursing Service ProvidersRegistered NurseRegistered Nurse First Assistant

No ID Information.


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