MEDICARE: MRS. SUSAN NUTAKOR-DOH FNP

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	336541	NY

General Provider Information

NPI Number	:	1134414360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN NUTAKOR-DOH FNP

Provider Business Mailing Address
First Line	:	7502 AUSTIN ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6237
Country	:	US
Telephone Number	:	718-268-0719
Fax Number	:

Provider Business Practice Location Address
First Line	:	7502 AUSTIN ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6237
Country	:	US
Telephone Number	:	718-268-0719
Fax Number	:

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	05/29/2015

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