Provider Demographics
NPI:1205061066
Name:STUBENHOFER, SUSAN M (CRNA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:STUBENHOFER
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:PO BOX 6490
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-6490
Mailing Address - Country:US
Mailing Address - Phone:814-453-3900
Mailing Address - Fax:814-453-2847
Practice Address - Street 1:200 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1420
Practice Address - Country:US
Practice Address - Phone:814-453-3900
Practice Address - Fax:814-453-2847
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN548349367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered