Provider Demographics
NPI:1154507572
Name:SIROKI, SUZANNE CHRISTINE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:CHRISTINE
Last Name:SIROKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:CHRISTINE
Other - Last Name:SIROKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:495 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-7311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:495 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7311
Practice Address - Country:US
Practice Address - Phone:717-253-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0127711041C0700X
PASP012875363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102272218Medicaid