Healthcare Provider Details

I. General information

NPI: 1467831719
Provider Name (Legal Business Name): SUSAN ENGLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN HOUSER

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 08/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 9TH AVENUE, SUITE 2B
ALTOOONA PA
16602
US

IV. Provider business mailing address

2525 9TH AVENUE, SUITE 2B
ALTOOONA PA
16602
US

V. Phone/Fax

Practice location:
  • Phone: 814-300-2273
  • Fax:
Mailing address:
  • Phone: 814-300-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP0001763B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: