MEDICARE: SUSAN M FEDERICO WHNP BC

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	363L00000X	Nurse Practitioner	26NJ00986200	NJ

General Provider Information

NPI Number	:	1932745759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M FEDERICO WHNP BC

Provider Business Mailing Address
First Line	:	897 12TH ST STE 103
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-1363
Country	:	US
Telephone Number	:	609-402-4900
Fax Number	:	609-402-4944

Provider Business Practice Location Address
First Line	:	897 12TH ST STE 103
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-1363
Country	:	US
Telephone Number	:	609-402-4900
Fax Number	:	609-402-4944

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

Provider Enumeration Date	:	11/27/2019
Last Update Date	:	05/09/2025

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Directions to “ SUSAN M FEDERICO WHNP BC” Practice Location

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