Provider Demographics
NPI:1184792772
Name:GALICZYNSKI, SUSAN FRANCES (RN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:FRANCES
Last Name:GALICZYNSKI
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:810 UNRUH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-4830
Mailing Address - Country:US
Mailing Address - Phone:215-722-2735
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:VIVACQUA PAVILION, SUITE 440
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-447-6695
Practice Address - Fax:610-447-6088
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005065C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health