Provider Demographics
NPI:1821466079
Name:JANUSZEWSKI, SUSAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:JANUSZEWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 NEWELL ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5314
Mailing Address - Country:US
Mailing Address - Phone:315-235-9348
Mailing Address - Fax:315-368-6709
Practice Address - Street 1:190 BOOTH ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-1504
Practice Address - Country:US
Practice Address - Phone:315-368-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304327163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse