Carlisle, Susan

Carlisle, Susan is an individual health care provider with primary practice located at 10 Brentwood Dr Suite B, Ithaca NY 14850-1865. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Carlisle, Susan can be contacted via phone (607) 266-0073.

Contact Information

Primary practice address
10 Brentwood Dr Suite B Ithaca NY 14850-1865
Phone: (607) 266-0073
Fax: (607) 266-9310
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0000081 New York
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 005198-1 New York

Profile Details

NPI number 1225042443
LBN Legal business name Carlisle, Susan
Credentials RPA-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Mar 10th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225042443 NPPES
New York MEDICAID 01611072

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