Healthcare Provider Details

I. General information

NPI: 1003894114
Provider Name (Legal Business Name): SUSAN U HAIKES MSN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 MAIN ST
DICKSON CITY PA
18519-1668
US

IV. Provider business mailing address

3 W OLIVE ST STE 118
SCRANTON PA
18508-2572
US

V. Phone/Fax

Practice location:
  • Phone: 570-307-1767
  • Fax: 570-307-1778
Mailing address:
  • Phone: 570-961-3823
  • Fax: 570-207-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN332858L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP004490B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: