Provider Demographics
NPI:1003846122
Name:MACKNAIR, SUSAN E (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:MACKNAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:62 HACKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1756
Mailing Address - Country:US
Mailing Address - Phone:518-465-3318
Mailing Address - Fax:518-272-7458
Practice Address - Street 1:62 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1756
Practice Address - Country:US
Practice Address - Phone:518-465-3318
Practice Address - Fax:518-272-7458
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420016-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4912Medicare UPIN
NYJ400060845Medicare PIN