Provider Demographics
NPI:1528558202
Name:ACKER, SUSAN E (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:ACKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:DYNAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2007
Mailing Address - Country:US
Mailing Address - Phone:716-884-0700
Mailing Address - Fax:716-884-0631
Practice Address - Street 1:1050 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213
Practice Address - Country:US
Practice Address - Phone:716-884-0700
Practice Address - Fax:716-884-0631
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY591262163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse