Healthcare Provider Details

I. General information

NPI: 1780878124
Provider Name (Legal Business Name): SUSAN ANNE GARRUTO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WALNUT ST 2ND FLOOR
PHILADELPHIA PA
19107-5211
US

IV. Provider business mailing address

20 FAWNWOOD DR
VOORHEES NJ
08043-3944
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7000
  • Fax:
Mailing address:
  • Phone: 856-767-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN250407L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR14086200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00197200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010141
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: