MEDICARE: MRS. SUSAN W NORDLOF 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	363LP0200X	Pediatric Nurse Practitioner	UP005385D	PA

General Provider Information

NPI Number	:	1235186321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN W NORDLOF CRNP

Provider Business Mailing Address
First Line	:	7056 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1826
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

Provider Business Practice Location Address
First Line	:	7056 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1826
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/19/2011

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