Provider Demographics
NPI:1174852487
Name:WARD, SUSANA MARY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:MARY
Last Name:WARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 OLD YORK RD STE 620
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3719
Mailing Address - Country:US
Mailing Address - Phone:215-885-8700
Mailing Address - Fax:215-885-8795
Practice Address - Street 1:261 OLD YORK RD STE 620
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3719
Practice Address - Country:US
Practice Address - Phone:215-885-8700
Practice Address - Fax:215-885-8795
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008444363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics