Provider Demographics
NPI:1932500436
Name:SUSAN BARB CRNP, LLC
Entity Type:Organization
Organization Name:SUSAN BARB CRNP, LLC
Other - Org Name:DELCO FAMILY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARB
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-447-0609
Mailing Address - Street 1:1401 CHESTER PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1336
Mailing Address - Country:US
Mailing Address - Phone:610-447-0609
Mailing Address - Fax:610-649-4421
Practice Address - Street 1:1401 CHESTER PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1336
Practice Address - Country:US
Practice Address - Phone:610-447-0609
Practice Address - Fax:610-649-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103030178-0001Medicaid
PA397890Medicare PIN