Provider Demographics
NPI:1144594680
Name:COREY, SUSAN CAROLYN (DNP, APN-BC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CAROLYN
Last Name:COREY
Suffix:
Gender:F
Credentials:DNP, APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E HORST AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7742
Mailing Address - Country:US
Mailing Address - Phone:717-304-2390
Mailing Address - Fax:
Practice Address - Street 1:506 UNION ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1047
Practice Address - Country:US
Practice Address - Phone:302-644-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACNS000048364SP0809X
DELE-0000185363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA241466Medicare PIN
DE241466Medicare PIN