Provider Demographics
NPI:1467614230
Name:PONIVAS, SUSAN JANE (RN, ANP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANE
Last Name:PONIVAS
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Gender:F
Credentials:RN, ANP
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Mailing Address - Street 1:709 N JUSTICE ST
Mailing Address - Street 2:STE A
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3455
Mailing Address - Country:US
Mailing Address - Phone:828-697-7377
Mailing Address - Fax:828-697-7380
Practice Address - Street 1:602 IVY ST FL 2
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1646
Practice Address - Country:US
Practice Address - Phone:607-737-4333
Practice Address - Fax:607-737-4271
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2021-11-11
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Provider Licenses
StateLicense IDTaxonomies
NC5015271363L00000X
NY304914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04652273Medicaid