Provider Demographics
NPI:1942440250
Name:DRAPER, SUSAN MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:DRAPER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 ROUTE 25A
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8802
Mailing Address - Country:US
Mailing Address - Phone:631-744-3671
Mailing Address - Fax:631-744-6205
Practice Address - Street 1:333 ROUTE 25A
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8802
Practice Address - Country:US
Practice Address - Phone:631-744-3671
Practice Address - Fax:631-744-6205
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY379559163W00000X
IL044572367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse