Provider Demographics
NPI:1821019670
Name:PUGLISI, SUSAN M (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PUGLISI
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 1:476 ROLLING RIDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7639
Mailing Address - Country:US
Mailing Address - Phone:814-689-4980
Mailing Address - Fax:814-689-4990
Practice Address - Street 1:476 ROLLING RIDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7639
Practice Address - Country:US
Practice Address - Phone:814-689-4980
Practice Address - Fax:814-689-4990
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P14937Medicare UPIN
CC2300Medicare ID - Type Unspecified