Provider Demographics
NPI:1144582990
Name:KEIM, SUSAN K (MSN, MS, CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:KEIM
Suffix:
Gender:F
Credentials:MSN, MS, CRNP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:705 MAPLE LEAF LN
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1841
Mailing Address - Country:US
Mailing Address - Phone:856-235-5685
Mailing Address - Fax:
Practice Address - Street 1:2100 SPRING GARDEN ST
Practice Address - Street 2:3RD FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3502
Practice Address - Country:US
Practice Address - Phone:215-988-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011890363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health