MEDICARE: MS. SUSAN L CHUDZIK CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	LG0000243	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063415651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN L CHUDZIK CRNP

Provider Business Mailing Address
First Line	:	4735 OGLETOWN STANTON RD
Second Line	:	MAPII SUITE 2123
City	:	NEWARK
State	:	DE
Zip	:	19713-2072
Country	:	US
Telephone Number	:	302-623-2451
Fax Number	:	302-623-2454

Provider Business Practice Location Address
First Line	:	4735 OGLETOWN STANTON RD
Second Line	:	MAPII SUITE 2123
City	:	NEWARK
State	:	DE
Zip	:	19713-2072
Country	:	US
Telephone Number	:	302-225-3888
Fax Number	:	302-731-7831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/08/2016

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