Provider Demographics
NPI:1699015537
Name:O'BRIEN, SUZANNE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:606 CUSTIS RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2014
Mailing Address - Country:US
Mailing Address - Phone:215-384-3547
Mailing Address - Fax:
Practice Address - Street 1:606 CUSTIS RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-2014
Practice Address - Country:US
Practice Address - Phone:215-384-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004873C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health