Provider Demographics
NPI:1376904193
Name:KOSHY, SUSAN (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KOSHY
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 1:33 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2713
Mailing Address - Country:US
Mailing Address - Phone:215-662-7366
Mailing Address - Fax:
Practice Address - Street 1:33 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:PA
Practice Address - Zip Code:19118-2713
Practice Address - Country:US
Practice Address - Phone:215-662-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP 015634363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care