MEDICARE: SUSAN KELLY NP

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	005848	PA

General Provider Information

NPI Number	:	1942351242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KELLY NP

Provider Business Mailing Address
First Line	:	3515 WASHINGTON RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-3063
Country	:	US
Telephone Number	:	724-969-4321
Fax Number	:	724-941-6948

Provider Business Practice Location Address
First Line	:	3515 WASHINGTON RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-3063
Country	:	US
Telephone Number	:	724-969-4321
Fax Number	:	724-941-6948

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	04/23/2009

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