Healthcare Provider Details

I. General information

NPI: 1154507572
Provider Name (Legal Business Name): SUZANNE CHRISTINE SIROKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN CHRISTINE SIROKI CRNP

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 GLENWOOD DR
GETTYSBURG PA
17325-7311
US

IV. Provider business mailing address

495 GLENWOOD DR
GETTYSBURG PA
17325-7311
US

V. Phone/Fax

Practice location:
  • Phone: 717-253-5289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP012875
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012771
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: