Provider Demographics
NPI:1689606147
Name:RAIA, SUSAN M (RN,APN,C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:RAIA
Suffix:
Gender:F
Credentials:RN,APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HUNTER RD S
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-3300
Mailing Address - Country:US
Mailing Address - Phone:973-636-9189
Mailing Address - Fax:
Practice Address - Street 1:20 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3127
Practice Address - Country:US
Practice Address - Phone:973-645-3042
Practice Address - Fax:973-622-4813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04882200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health