Provider Demographics
NPI:1972397578
Name:BRICE, SUSAN MCCLURKIN (LPN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MCCLURKIN
Last Name:BRICE
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2887
Mailing Address - Country:US
Mailing Address - Phone:518-741-2103
Mailing Address - Fax:
Practice Address - Street 1:444 BROADWAY
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2887
Practice Address - Country:US
Practice Address - Phone:518-741-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263857-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty