Provider Demographics
NPI:1528288222
Name:PLATT, SUSAN ERKENBRACK (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ERKENBRACK
Last Name:PLATT
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAREN
Other - Last Name:ERKENBRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1388 SAND HILL RD
Practice Address - Street 2:MISSION MY CARE PLUS CANDLER
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8937
Practice Address - Country:US
Practice Address - Phone:828-213-5335
Practice Address - Fax:828-213-5336
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC242852363LF0000X
NC5005143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1528288222Medicaid
NC1528288222Medicaid