Provider Demographics
NPI:1639546575
Name:MILLER, SUSAN E
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:ZINDREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:871 LITTLE CONESTOGA RD
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-2009
Mailing Address - Country:US
Mailing Address - Phone:610-662-8692
Mailing Address - Fax:
Practice Address - Street 1:871 LITTLE CONESTOGA RD
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-2009
Practice Address - Country:US
Practice Address - Phone:610-662-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily