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General NPI Number Information
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NPI Number | 1780566679
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Entity Type | Individual
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Provider Name | SUSAN MARIE TYSON BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 503 N 21ST ST
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City | CAMP HILL
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State | PA
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Zip | 17011-2204
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Country | US
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Telephone | 717-972-4301
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Fax |
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Provider Business Mailing Address
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Address Line | 4428 MARS AVE
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City | HARRISBURG
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State | PA
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Zip | 17112-9120
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Country | US
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Telephone | 717-576-1787
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN294082L
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License Number State | PA
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