Healthcare Provider Details

I. General information

NPI: 1932277241
Provider Name (Legal Business Name): SUZANNE DRAKE PHD APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 D LAKE STREET SUITE 2
RAMSEY NJ
07446-1243
US

IV. Provider business mailing address

400 D LAKE STREET SUITE 2
RAMSEY NJ
07446-1243
US

V. Phone/Fax

Practice location:
  • Phone: 201-818-9401
  • Fax: 908-754-5907
Mailing address:
  • Phone: 201-818-9401
  • Fax: 908-754-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NC06945900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number217409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: