Provider Demographics
NPI:1447461314
Name:KIRWAN, SUSAN MARY (EDD, MSN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARY
Last Name:KIRWAN
Suffix:
Gender:F
Credentials:EDD, MSN, CPNP-PC
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:M
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, MSN, CPNP-PC
Mailing Address - Street 1:50 MINERAL SPRING LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5734
Mailing Address - Country:US
Mailing Address - Phone:301-785-4872
Mailing Address - Fax:
Practice Address - Street 1:7205 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1649
Practice Address - Country:US
Practice Address - Phone:919-848-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167791363LP0200X
TX579151363LP0200X
NC5009929363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447461314Medicaid
MDS118Medicare PIN
MD211862Medicare Oscar/Certification