Healthcare Provider Details

I. General information

NPI: 1720632524
Provider Name (Legal Business Name): SUZANNE CARROLL-KELLY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E BROWN ST
EAST STROUDSBURG PA
18301-3006
US

IV. Provider business mailing address

2100 MACK BLVD FL 2
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 570-476-3700
  • Fax: 570-476-3637
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020313
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: