Healthcare Provider Details

I. General information

NPI: 1447691498
Provider Name (Legal Business Name): ALTHEA RUTH SUSLIK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2013
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING ST
AUBURN NY
13021-1983
US

IV. Provider business mailing address

37 W GARDEN ST SUITE 105
AUBURN NY
13021-2662
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0437
  • Fax:
Mailing address:
  • Phone: 315-252-0000
  • Fax: 315-252-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338177
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: