Healthcare Provider Details

I. General information

NPI: 1235186321
Provider Name (Legal Business Name): SUSAN W NORDLOF CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7056 GERMANTOWN AVE
PHILADELPHIA PA
19119-1826
US

IV. Provider business mailing address

7056 GERMANTOWN AVE
PHILADELPHIA PA
19119-1826
US

V. Phone/Fax

Practice location:
  • Phone: 215-247-2996
  • Fax: 215-247-7504
Mailing address:
  • Phone: 215-247-2996
  • Fax: 215-247-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberUP005385D
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: