Provider Demographics
NPI:1568573244
Name:WINCHESTER, SUSAN B (RN,MS,FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:RN,MS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:989 ROUTE 146
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3646
Mailing Address - Country:US
Mailing Address - Phone:518-383-0891
Mailing Address - Fax:518-383-1662
Practice Address - Street 1:989 ROUTE 146
Practice Address - Street 2:BUILDING 200
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3646
Practice Address - Country:US
Practice Address - Phone:518-383-0891
Practice Address - Fax:518-383-1662
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102388OtherGHI/HMO
NY02713959Medicaid
NY385801OtherMVP HEALTHCARE
NY000410779001OtherBSNENY
NY070327000106OtherFIDELIS
NY200439OtherSENIOR WHOLE HEALTH
NY070327000106OtherFIDELIS
NY385801OtherMVP HEALTHCARE