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General NPI Number Information
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NPI Number | 1649755190
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Entity Type | Individual
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Provider Name | SUSANNAH COOPER SPERO MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 110 HO PLZ
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City | ITHACA
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State | NY
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Zip | 14853-3102
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Country | US
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Telephone | 607-255-5155
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Fax |
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Provider Business Mailing Address
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Address Line | 110 HO PLZ
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City | ITHACA
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State | NY
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Zip | 14853-3102
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Country | US
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Telephone |
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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 | RN-89507
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 217929
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 790555
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 225421
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 217929
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F347658
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License Number State | NY
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