Provider Demographics
NPI:1225453657
Name:PETRI, SUSAN (APN CRNA RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PETRI
Suffix:
Gender:F
Credentials:APN CRNA RN
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:TORCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN CRNA RN
Mailing Address - Street 1:187 MILLBURN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1847
Mailing Address - Country:US
Mailing Address - Phone:973-467-1466
Mailing Address - Fax:
Practice Address - Street 1:187 MILLBURN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1847
Practice Address - Country:US
Practice Address - Phone:973-467-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00482000367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered