Healthcare Provider Details

I. General information

NPI: 1033467741
Provider Name (Legal Business Name): SUSANN RAE KROPP R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 ROUTE 145
DURHAM NY
12422-5121
US

IV. Provider business mailing address

4099 ROUTE 145
DURHAM NY
12422-5121
US

V. Phone/Fax

Practice location:
  • Phone: 518-239-4287
  • Fax:
Mailing address:
  • Phone: 518-239-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number518278-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: