Provider Demographics
NPI:1679618367
Name:CULVERN, SUSAN (DPH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:CULVERN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5823
Mailing Address - Country:US
Mailing Address - Phone:423-586-8768
Mailing Address - Fax:
Practice Address - Street 1:3606 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3603
Practice Address - Country:US
Practice Address - Phone:423-587-4107
Practice Address - Fax:423-587-4091
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6941183500000X
AL10268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist