Provider Demographics
NPI:1558681825
Name:WILK-SCHANK, SUSANNE (RN,MS,FNP)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:WILK-SCHANK
Suffix:
Gender:F
Credentials:RN,MS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 SHERIDAN DR
Mailing Address - Street 2:1B
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3730
Mailing Address - Country:US
Mailing Address - Phone:716-636-1947
Mailing Address - Fax:716-636-1369
Practice Address - Street 1:5530 SHERIDAN DR
Practice Address - Street 2:1B
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3730
Practice Address - Country:US
Practice Address - Phone:716-636-1947
Practice Address - Fax:716-636-1369
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3306431364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512954OtherINDEPENDENT HEALTH
NY000560178004OtherBLU CROSS BLUE SHIELD
NY00027195301OtherUNIVERA