Provider Demographics
NPI:1336458975
Name:MOORE, SUSAN LYNN (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:MARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1499
Mailing Address - Country:US
Mailing Address - Phone:484-628-8408
Mailing Address - Fax:484-628-8382
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 1020
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1499
Practice Address - Country:US
Practice Address - Phone:484-628-8408
Practice Address - Fax:484-628-8382
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169020363LW0102X
PASP011177363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health