MEDICARE: MS. SUSAN BARB CRNP

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	363LF0000X	Family Nurse Practitioner	SP011731	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457638074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN BARB CRNP

Provider Business Mailing Address
First Line	:	1401 CHESTER PIKE
Second Line	:	SUITE B
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1336
Country	:	US
Telephone Number	:	610-447-0609
Fax Number	:	610-649-4421

Provider Business Practice Location Address
First Line	:	1401 CHESTER PIKE
Second Line	:	SUITE B
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1336
Country	:	US
Telephone Number	:	610-447-0609
Fax Number	:	610-649-4421

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

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	10/02/2015

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