Provider Demographics
NPI:1740242064
Name:SCANLAND, SUSAN GEORGEANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GEORGEANN
Last Name:SCANLAND
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:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-0777
Mailing Address - Country:US
Mailing Address - Phone:570-586-0655
Mailing Address - Fax:570-586-5174
Practice Address - Street 1:501 S WASHINGTON AVE STE 1000
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3814
Practice Address - Country:US
Practice Address - Phone:570-941-0630
Practice Address - Fax:570-230-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000593C363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS93175Medicare UPIN
PA022849Medicare ID - Type Unspecified