Provider Demographics
NPI:1003894114
Name:HAIKES, SUSAN U (MSN CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:U
Last Name:HAIKES
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 W OLIVE ST
Mailing Address - Street 2:STE 118
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2572
Mailing Address - Country:US
Mailing Address - Phone:570-961-3823
Mailing Address - Fax:570-207-5988
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1668
Practice Address - Country:US
Practice Address - Phone:570-307-1767
Practice Address - Fax:570-307-1778
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN332858L363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA08286D01Medicare ID - Type Unspecified
S62301Medicare UPIN