=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245602887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN MARCHEZAK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2015
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 PENN AVE
-----------------------------------------------------
City | WILKINSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15221-2117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-336-2002
-----------------------------------------------------
Fax | 412-693-9787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 746722
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-6722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-352-1515
-----------------------------------------------------
Fax | 312-929-0373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP015308
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------