Provider Demographics
NPI:1063250462
Name:CAVANAUGH, SUSAN JACQUELYN (AGNP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JACQUELYN
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MASON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-6134
Mailing Address - Country:US
Mailing Address - Phone:984-974-4175
Mailing Address - Fax:
Practice Address - Street 1:102 MASON FARM RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-6134
Practice Address - Country:US
Practice Address - Phone:919-974-4175
Practice Address - Fax:984-974-6741
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCAVA-K7UWK363LA2200X
NC5020484363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health