| Doctor Name: | SUSAN ULLRICH |
| NPI Number: | 1184927055 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN CDE |
| License Number: | 571073-1 |
| Business Practice Address: | 2 Coulter Rd Diabetes Health Center Clifton Springs, NY - 144321122 |
| Business Phone Number: | 3154620220 |
| Business Fax Number: | 3154623767 |
| Mailing Address: | 2 Coulter Rd, Diabetes Health Center CLIFTON SPRINGS |
| State: | NY |
| Postal Code: | 144321122 |
| Phone Number: | 3154620220 |
| Fax Number: | 3154623767 |
| NPI Enumeration Date: | 12/14/2010 |
| NPI Last Update Date: | 12/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | 571073-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |