Provider Demographics
NPI:1033385075
Name:BEGASSE, SUSAN MARIE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:BEGASSE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17382 STATE ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-7776
Mailing Address - Country:US
Mailing Address - Phone:570-465-5151
Mailing Address - Fax:570-465-5154
Practice Address - Street 1:17382 STATE ROUTE 11
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-7776
Practice Address - Country:US
Practice Address - Phone:570-465-5151
Practice Address - Fax:570-465-5154
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP-004864-B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR88737Medicare UPIN
NY005585Medicare PIN