Provider Demographics
NPI:1093029738
Name:SURANIE, BRIDGET E (CRNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:E
Last Name:SURANIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:E
Other - Last Name:COYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:100 E. LANCASTER AVE
Mailing Address - Street 2:JD LANKENAU PAVILION, MEZZANINE
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-476-1000
Mailing Address - Fax:484-476-9000
Practice Address - Street 1:100 E. LANCASTER AVE
Practice Address - Street 2:JD LANKENAU PAVILION, MEZZANINE
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-1000
Practice Address - Fax:484-476-9000
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006292C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2359401OtherMAIN LINE HEALTHCARE TIN
PA189917HK1Medicare PIN