Provider Demographics
NPI:1578801841
Name:SPADT, SUSAN KELLOGG (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KELLOGG
Last Name:SPADT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING 1, SUITE 300
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-656-6580
Mailing Address - Fax:610-525-3664
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING 1, SUITE 300
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-656-6580
Practice Address - Fax:610-525-3664
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PATP0001893G363L00000X
PATP001893G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health