Provider Demographics
NPI:1861491102
Name:MAYKISH, SUSAN JEAN (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JEAN
Last Name:MAYKISH
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE405
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-829-9998
Mailing Address - Fax:973-829-9991
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE405
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-829-9998
Practice Address - Fax:973-829-9991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJNN073548363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health