Healthcare Provider Details

I. General information

NPI: 1467796300
Provider Name (Legal Business Name): SUSAN BEARDSLEY SECKINGER R. N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S BROAD ST
PHILADELPHIA PA
19145-2328
US

IV. Provider business mailing address

7 N COLUMBUS BLVD PIER 5 UNIT 134
PHILADELPHIA PA
19106-1422
US

V. Phone/Fax

Practice location:
  • Phone: 215-339-4563
  • Fax:
Mailing address:
  • Phone: 267-825-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN291146L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP018052
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: