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General NPI Number Information
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NPI Number | 1104710581
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Entity Type | Individual
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Provider Name | SUSAN KUPSTAS CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 169 N PENNSYLVANIA AVE
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City | WILKES BARRE
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State | PA
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Zip | 18701-3603
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Country | US
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Telephone | 570-491-0126
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Fax | 570-230-0013
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Provider Business Mailing Address
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Address Line | 298 RIDGE ST
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City | HANOVER TOWNSHIP
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State | PA
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Zip | 18706-3037
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Country | US
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Telephone | 570-709-9353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN631817
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP033418
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License Number State | PA
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