Provider Demographics
NPI:1659650299
Name:SUSI BOHENEK, THERESA (CRNP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:SUSI BOHENEK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LORNA DR
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1706
Mailing Address - Country:US
Mailing Address - Phone:215-441-0865
Mailing Address - Fax:
Practice Address - Street 1:210 LORNA DR
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-1706
Practice Address - Country:US
Practice Address - Phone:215-441-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN226141L163W00000X
PASP010997363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse