Healthcare Provider Details

I. General information

NPI: 1639118250
Provider Name (Legal Business Name): SUSAN RUMPF MIESNIK MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S 34TH ST WOOD BUILDING, ROOM 5135
PHILADELPHIA PA
19104-4304
US

IV. Provider business mailing address

1562 WHEATFIELD LN
WARMINSTER PA
18974-1845
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-5925
  • Fax: 215-590-2447
Mailing address:
  • Phone: 215-343-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberUP003971T
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: