Provider Demographics
NPI:1114172020
Name:TERWILLIGER, SUSAN (EDD, BS, PNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TERWILLIGER
Suffix:
Gender:F
Credentials:EDD, BS, PNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:GUTHRIE CLINIC - PEDIATRICS
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:607-565-4652
Mailing Address - Fax:607-777-4440
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-887-3070
Practice Address - Fax:570-887-3382
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380333-1363LP0200X
PATP002073D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03081490Medicaid