Provider Demographics
NPI:1114044161
Name:MCCOLLEY, SUSAN F (RN, MSN, APNC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:F
Last Name:MCCOLLEY
Suffix:
Gender:F
Credentials:RN, MSN, APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1915
Mailing Address - Country:US
Mailing Address - Phone:732-738-0876
Mailing Address - Fax:
Practice Address - Street 1:1550 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5565
Practice Address - Country:US
Practice Address - Phone:908-757-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN97986363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8773700Medicaid