Healthcare Provider Details

I. General information

NPI: 1336458975
Provider Name (Legal Business Name): SUSAN LYNN MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN LYNN MARTZ

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 HELEN DR
LEBANON PA
17042-7493
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-8835
  • Fax:
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024169020
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP011177
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: