Healthcare Provider Details

I. General information

NPI: 1104886274
Provider Name (Legal Business Name): SUSAN LYNN SKOTLESKI KRUM MSN/CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
LEWISBURG PA
17837-9350
US

IV. Provider business mailing address

1 HOSPITAL DR SUITE 306
LEWISBURG PA
17837-9350
US

V. Phone/Fax

Practice location:
  • Phone: 570-522-4200
  • Fax: 570-522-4203
Mailing address:
  • Phone: 570-522-4110
  • Fax: 570-768-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberVP001145G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: