Provider Demographics
NPI:1710574975
Name:ELUWA, SUSAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ELUWA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 BROCKLEHURST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3502
Mailing Address - Country:US
Mailing Address - Phone:267-315-8876
Mailing Address - Fax:
Practice Address - Street 1:860 1ST AVE STE 3
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-265-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily