MEDICARE: SUSAN R FAIR 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	363LW0102X	Women's Health Nurse Practitioner	TP004402Y	PA

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	:	1174523328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN R FAIR CRNP

Provider Business Mailing Address
First Line	:	6998 CRIDER RD STE 120
Second Line	:
City	:	MARS
State	:	PA
Zip	:	16046-2390
Country	:	US
Telephone Number	:	724-742-3820
Fax Number	:	724-742-3838

Provider Business Practice Location Address
First Line	:	6998 CRIDER RD STE 120
Second Line	:
City	:	MARS
State	:	PA
Zip	:	16046-2390
Country	:	US
Telephone Number	:	724-742-3820
Fax Number	:	724-742-3838

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	01/25/2017

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