Provider Demographics
NPI:1437177557
Name:HOLT, SUSAN (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HOLT
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 1:40 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1224
Mailing Address - Country:US
Mailing Address - Phone:610-374-7400
Mailing Address - Fax:610-374-1641
Practice Address - Street 1:40 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1224
Practice Address - Country:US
Practice Address - Phone:610-374-7400
Practice Address - Fax:610-374-1641
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004922D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAUP004922DOtherNURSING LICENSE