Provider Demographics
NPI:1265638985
Name:LARVIE, SUSANA (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:SUSANA
Middle Name:
Last Name:LARVIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:SUSANA
Other - Middle Name:EUNICE
Other - Last Name:TETTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:21 W LEXTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-8824
Mailing Address - Country:US
Mailing Address - Phone:267-467-2477
Mailing Address - Fax:
Practice Address - Street 1:1166 HILTS RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17368-9205
Practice Address - Country:US
Practice Address - Phone:717-478-1616
Practice Address - Fax:717-252-6345
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN563757163W00000X
PASP017300363L00000X
DELG0001013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner