MEDICARE: SUSAN J WILSON RN,APN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SX0200X	Oncology Clinical Nurse Specialist	26NC07654700	NJ
2	364SX0200X	Oncology Clinical Nurse Specialist	26NR076554700	NJ

General Provider Information

NPI Number	:	1396757811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J WILSON RN,APN-C

Provider Business Mailing Address
First Line	:	210 SOUTH SHORE ROAD, SUITE 106
Second Line	:	HOPE COMMUNITY CANCER CENTER
City	:	MARMORA
State	:	NJ
Zip	:	08223-1271
Country	:	US
Telephone Number	:	609-390-7888
Fax Number	:	609-390-2614

Provider Business Practice Location Address
First Line	:	210 SOUTH SHORE ROAD, SUITE 106
Second Line	:	HOPE COMMUNITY CANCER CENTER
City	:	MARMORA
State	:	NJ
Zip	:	08223-1271
Country	:	US
Telephone Number	:	609-390-7888
Fax Number	:	609-390-2614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/27/2010

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