Provider Demographics
NPI:1518965409
Name:HAMO, SUSAN M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:HAMO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:ZABEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2211 GENESEE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-733-7598
Mailing Address - Fax:315-733-7694
Practice Address - Street 1:2211 GENESEE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501
Practice Address - Country:US
Practice Address - Phone:315-733-7598
Practice Address - Fax:315-733-7694
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331297-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02073518Medicaid
NYBB6416Medicare PIN
NYBB6416Medicare ID - Type Unspecified
NY02073518Medicaid