Provider Demographics
NPI:1144504515
Name:CROOM, SUSAN SUTTON (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SUTTON
Last Name:CROOM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 STROUDS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-7145
Mailing Address - Country:US
Mailing Address - Phone:252-559-8334
Mailing Address - Fax:
Practice Address - Street 1:801 LIONEL ST
Practice Address - Street 2:WISH
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2931
Practice Address - Country:US
Practice Address - Phone:919-739-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily