Provider Demographics
NPI:1902342520
Name:DAVIS, SUSAN LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:GLADOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8675
Mailing Address - Country:US
Mailing Address - Phone:907-602-0403
Mailing Address - Fax:
Practice Address - Street 1:4300 B ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5933
Practice Address - Country:US
Practice Address - Phone:907-375-3355
Practice Address - Fax:907-375-3351
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20715363LF0000X
AK140643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily