Provider Demographics
NPI:1538534714
Name:FRIDLEY, SUSAN E (RN, BSN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:FRIDLEY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18866 CHARLES TOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-5503
Mailing Address - Country:US
Mailing Address - Phone:304-724-3303
Mailing Address - Fax:304-728-7041
Practice Address - Street 1:18866 CHARLES TOWN RD
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-5503
Practice Address - Country:US
Practice Address - Phone:304-724-3303
Practice Address - Fax:304-728-7041
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47944163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool