MEDICARE: SUSAN RUETER MCGINLEY 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	363LA2200X	Adult Health Nurse Practitioner	SP007257	PA

General Provider Information

NPI Number	:	1972519619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN RUETER MCGINLEY CRNP

Provider Business Mailing Address
First Line	:	1800 LOMBARD ST
Second Line	:	STE 206
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1414
Country	:	US
Telephone Number	:	215-615-2222
Fax Number	:	215-893-7317

Provider Business Practice Location Address
First Line	:	1800 LOMBARD ST
Second Line	:	STE 206
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1414
Country	:	US
Telephone Number	:	215-615-2222
Fax Number	:	215-893-7317

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/10/2019

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